# Would you do it?



## SW-EMS (Mar 27, 2009)

Hi....I'm currently kicking around an idea and wanted to get some input.  I'm currently going through a MFR program (paid for by my employer).  I'm really interested in the things that I'm learning and enjoy the classes.  Our MFR course is actually taught with a hybrid type of curriculum, it's roughly 96 hours long, we use and EMT-B text....we just lack a few hours of class time to meet the EMT-B requirement.  

I'm thinking about going through EMT-I once I finish up MFR.  The few draw backs I have are as follows.  I work full time, the EMT-I course would come out of MY pocket (little over $3000).  I do not really intend to seek employ as an EMT.  My current job is more than enough to sustain my standard of living, but it would be nice to have as a fall back.

The reason I'm going through MFR and subsequently thinking about EMT-I is to be helpful for family members and co-workers.  I work in a manufacturing setting, we have a fairly low incident rate, but in the past have had injuries ranging from minor lacerations and contusions, to major trauma (cause by moving machinery, falls from heights etc.), and including two or three on site fatalities over the years.  I want to be able to help my co-workers, but would I really be of that much more help to them as an EMT-I?  Our facility is less than two miles from a hospital, but it is not a trauma center, and they do not have their own transport.  So transport could be 10-15 mins out.


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## Ridryder911 (Mar 27, 2009)

Why do it if you are not interested in doing it? We personally don't need just some more card carrying folks. 

Also most states require you to be active as an EMT/I to maintain your certification so in a way it maybe a waste of time. 

This is NOT a hobby and to be really proficient one has to ensure that they can maintain proficiency. You took a course that was proficient in meeting your needs and to be realistic the further up the chain, there is a large difference between the BLS and ALS education level (or at least should be). 

R/r 911


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## vquintessence (Mar 28, 2009)

If you're just getting it to be helpful for family/friends, then MFR should suit your needs fine.  Like Ryder said, you will have to pay to re-cert every two years as well as pay for con-ed to keep your certificate.  Also, I could be wrong but I don't think you can jump from MFR to EMT-I; you'd have to get your Basic first (another $1,000+).

As far as work goes, I assume you have at least an RN at your facility if you're a manufacturing plant?  Further going to assume that your company probably wouldn't let you intervene much more than basic first aid, so having a certificate for IV access and intubation may not even be applicable for you due to your employer.

It's noble and very respectable you have a desire to KNOW how to help family/friends/coworkers in the event of an emergency.  But like you said on your post, if the $3,000 class is already a burden, then consider the additional few hundred dollars you'd have to contribute biannually to just keep your certificate from expiring, along with the many hours you will have to devote on con-ed and skill proficiency as well as keeping up with the ever evolving field.


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## AJ Hidell (Mar 28, 2009)

As Rid said, this would be completely pointless on your part.  There is nothing taught in that course that would be of use to you in any situation other than working in EMS.  EMT-I is not just an extension of EMR.  It's not just more first aid.  It enters into the realm of medical practice, utilizing legally restricted devices and procedures that are rarely of any use even to the EMT-I working in the field, much less to the lay person.  You cannot do them without doctors orders.  And if you do not do them constantly, you will not have the slightest chance of retaining them anyhow, making it also useless as something to "fall back on".


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## fortsmithman (Mar 28, 2009)

If you're not going to be working EMS (911, IFT, or industrial)  stick with MFR.


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## SW-EMS (Mar 28, 2009)

fortsmithman - I don't plan to work EMS as a career.  Maybe some PT but I'm going to keep the job I have now.  You mentioned industrial as well as 911 and IFT, that's exactly what I'm referring to doing at my current job.  While my main task is to maintain the control systems of the machinery, if there is an injury then myself and/or the other first responders and EMT's we have onsite evaluate, treat, and or package if transport is required.


vquintessence  -  We do not have an RN on site except for drug screens, eye, and hearing exams bi-weekly.  Employer helps with the re-cert....employer actually provides EMT classes every now and then when there are enough people interested and economy is good. (just not lately)  Procedure wise, if it's within the scope of your training level they're ok with you doing it.  We have fully stocked drug boxes in each plant, and there have been occasions when IV's have been started on the plant floor by one of OUR EMT's.

EMS interests my greatly, it's just no feasible for my pay and benefit wise to change careers.  I must say that I'm somewhat surprised though.  Most threads I have read regarding education I've read here are in favor of it.  I am getting a feeling of being looked down upon because I asked about educating for a part time/secondary skill.....:sad:


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## AJ Hidell (Mar 28, 2009)

SW-EMS said:


> I must say that I'm somewhat surprised though.  Most threads I have read regarding education I've read here are in favor of it.  I am getting a feeling of being looked down upon because I asked about educating for a part time/secondary skill.....:sad:


Don't be silly.  Did you read the posts?  I mean like REALLY read them and comprehend them?  Nobody told you not to do it.  Waste your time and money in any way you want.  Go ahead, take a school seat away from someone who is trying to establish a career if that floats your boat.  Doesn't matter to me.  It's just an utter and complete waste of time and money for you, so we're saying that and nothing more.

Again IT IS NOT JUST MORE FIRST AID TRAINING.  I know that the disjointed, stair-step way that EMS education is currently laid out leads most n00bs to look at it that way, but that is not how it is.  EMT-I is medical education.  It will be of no more use to you than going to dental school then never practicing.  That's all we're saying.  If you didn't want to hear the truth, then you shouldn't have asked.


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## enjoynz (Mar 28, 2009)

I can understand you enjoying the class that you are doing and in a factory industry the MFR certificate is more than enough.
It's also more than enough to help your friends, co-workers and family until an ambulance arrives, which the hospital so close,
you are lucky (Ours is a 50 minute drive away).

It not just knowing how to be an EMT-I, you need the equipment (which is usually found on the ambulance) and ongoing training.
If you really enjoy the aspects of EMS practices, you need to at least join a volunteer (block your eyes you seasoned paid staff,
I don't want another Vollie bashing to start) or part-time paid position, to keep the skills up that a EMT-I is trained for.
So if you are happy to put forward $3000 and do the training, you really need to look to it as an ongoing second career!
EMS can be rewarding and also can be a strain at times. It can also take a lot of your spare time.
If you are happy at the thought of that...then go for it!!!

Cheers Enjoynz


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## Sasha (Mar 28, 2009)

> I must say that I'm somewhat surprised though. Most threads I have read regarding education I've read here are in favor of it. I am getting a feeling of being looked down upon because I asked about educating for a part time/secondary skill.....



Those who are in favor of more education are also in favor of EMS as a profession, and not just some part time hobby.


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## Veneficus (Mar 28, 2009)

Would you want to be treated by a doctor who went to medical school as a hobby or something to fall back on?

When we speak of increasing educational standards, we speak about a level that would make it impossible in all but the most rare circumstances for anyone not as a primary professional in medicine to meet.

Even if your MFR class used an EMT-Basic book, the skills Basics perform are rather benign. (please save your "we give nitro" type comments, we let patients give it to themselves)

As for advanced skills, I once said "a monkey could intubate." But apparently many providers can't, so I guess I am wrong about that. A drug abuser can start an IV, but rarely will that save a life by itself. Now you start having to make decisions, crystallod? Colloid? Which osmotic properties? How much fluid? 

Sure the cookbook may say 1000L normal saline for a dehydration patient. Are you going to do that to your patient who also has CHF? Why? Why not? When would you?

How about the guy that gets chopped up in the machines? IV with fluids wide open? May not be the best idea. 

How often will you intubate? (we know if you don't practice it, you will not be successful) That could actually do harm.

drugs? Indications, absolute contra indications? Relative contra indications? Side effects? Interactions? No way will you pick up all this in an EMT-I course, most medics are hard pressed for it. (unfortunately)

If you want to help your friends and family, there are better (aka more practical) ways than the EMT chain. If it is something you really want to do, go for it. But whether you do it part time, full time, or when the urge strikes you. You have the same requirements everyone else does. The same proficency and knowledge will be demanded; both by those in the field and in the legal community. If altruism is your goal, most hospitals could always use volunteers.


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## EMTWintz (Mar 28, 2009)

Sasha said:


> Those who are in favor of more education are also in favor of EMS as a profession, and not just some part time hobby.



Hey now, there are some of us who are not in EMS as a profession but take our "hobby" very seriously.


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## AJ Hidell (Mar 28, 2009)

EMTWintz said:


> Hey now, there are some of us who are not in EMS as a profession but take our "hobby" very seriously.


You also take jobs away from people with professional commitment who would like to devote to EMS as a career.  You also deny your community full-time professional coverage.  You also prevent educational levels from progressing.  Thanks for taking all that "very seriously".  You're my hero.


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## fortsmithman (Mar 28, 2009)

SW-EMS said:


> fortsmithman - I don't plan to work EMS as a career.  Maybe some PT but I'm going to keep the job I have now.  You mentioned industrial as well as 911 and IFT, that's exactly what I'm referring to doing at my current job.
> 
> :sad:



If your employer pays for it then go for it.  In Alberta Industrial EMS makes more than 911 and IFT EMS.  As well Alberta College of Paramedics requires its members to complete an online exam before being reregistered.  One of our EMRs said the online exam takes around 2 hours to complete.  I saw an ad for a  EMTs job with an industrial service and they paid 400/day with paramedics 675/day.   Like I said go for it and when you do take it try to get more of you job duties involving more to the EMT side.  For those that say EMTs need to use equipment found in the back of a 911 ambulance some of the industrial service trucks are better stocked that mot ambulances.


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## Foxbat (Mar 28, 2009)

SW-EMS said:


> I want to be able to help my co-workers, but would I really be of that much more help to them as an EMT-I?


Probably not.
As an EMT-I (as opposed to MFR and EMT-Basic), you will be able to perform interventions which:
a) require a lot of practice;
b) require equipment (IV supplies, intubation supplies) which your employer will probably not provide (and then there is the whole legal issue with it).
If you already were an EMT-I in an EMS service, (I have no desire to get involved into "volunteer vs. career" debate for 7868721-th time), and spent substantial amount of time treating patients outside your work, that might have been a different story. But where you are now, it is not worth it, IMO.


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## EMTWintz (Mar 29, 2009)

AJ Hidell said:


> You also take jobs away from people with professional commitment who would like to devote to EMS as a career.  You also deny your community full-time professional coverage.  You also prevent educational levels from progressing.  Thanks for taking all that "very seriously".  You're my hero.



Hey if you are offering to move to "small town IL" i will all but give you my spot on this squad on a golden platter. Until then I, and others just as devoted as me, are all that this town has. Prevent edicational levels from progressing? WTF? Tell me the point of getting a  medic license for a BLS squad. We have all the coverage that this town needs. There is always at least two EMTB's in town plus a driver at all times, as most of us have adjusted our work schedules to accomodate the needs of the town.
To the people in this town we are a God Send. And that is all I give a rat's arse about.


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## Sasha (Mar 29, 2009)

EMTWintz said:


> Hey if you are offering to move to "small town IL" i will all but give you my spot on this squad on a golden platter. Until then I, and others just as devoted as me, are all that this town has. Prevent edicational levels from progressing? WTF? Tell me the point of getting a  medic license for a BLS squad. We have all the coverage that this town needs. There is always at least two EMTB's in town plus a driver at all times, as most of us have adjusted our work schedules to accomodate the needs of the town.
> To the people in this town we are a God Send. And that is all I give a rat's arse about.



So you're saying your town has no need for ALS? 

Tell that to your next CHFer coughing up pink frothy stuff!


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## Ridryder911 (Mar 29, 2009)

EMTWintz said:


> Hey if you are offering to move to "small town IL" i will all but give you my spot on this squad on a golden platter. Until then I, and others just as devoted as me, are all that this town has. Prevent edicational levels from progressing? WTF? Tell me the point of getting a  medic license for a BLS squad. We have all the coverage that this town needs. There is always at least two EMTB's in town plus a driver at all times, as most of us have adjusted our work schedules to accomodate the needs of the town.
> To the people in this town we are a God Send. And that is all I give a rat's arse about.



I used to say ignorance was blessed.. but this borders upon stupidity. Please tell me about the aspiration pneumonia patient that died because you were unable to intubate and secure their airway, or the life threatening AMI that was increasing infarct size or the patient with pain and you could not administer an analgesic. Now, what exactly will you a ..."God send".. going to do for that premi birth?  Are you preventing those brain cells from dying due to hypoglycemia? I wonder how your community would feel if they knew they could provide almost the same care with a Boy Scout first aid course? God send? Yes, first aid is essential but please, please don't disguise yourself as medical providers.  

Better quit patting yourself on the back before you need to call a Paramedic to administer pain med.'s.. 

Yes, you and I do mean you are one of the downfalls of prehospital care! It is the ignorant providers as such.  Did you rally in support of increasing the level of care or rendezvous with an ALS? Or are you part of the whining, crying of how hard EMS courses have become? Did you participate in studies of possibly funding a real EMS? ..............I didn't think so..
No, it is exactly people like you who like to blow their own horn instead of progressing onward. The same people that are protesting increased education and accreditation because it will be "too tough" on the caring citizens. 

I do thank you though. You are exactly the reason there is such an opinion of why EMS should be primarily professional and only per ALS personnel. You demonstrated the exact reason why we still have a crappy EMS system within the U.S. borders. 

I ask you this; how does it feel to deliver inefficient care more than Johnny & Roy did nearly 40 years ago? .. God send? .. I think not; deterimental? Possibly. 

R/r 911


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## EMTWintz (Mar 29, 2009)

Ridryder911 said:


> I used to say ignorance was blessed.. but this borders upon stupidity. Please tell me about the aspiration pneumonia patient that died because you were unable to intubate and secure their airway, or the life threatening AMI that was increasing infarct size or the patient with pain and you could not administer an analgesic. Now, what exactly will you a ..."God send".. going to do for that premi birth?  Are you preventing those brain cells from dying due to hypoglycemia? I wonder how your community would feel if they knew they could provide almost the same care with a Boy Scout first aid course? God send? Yes, first aid is essential but please, please don't disguise yourself as medical providers.
> 
> Better quit patting yourself on the back before you need to call a Paramedic to administer pain med.'s..
> 
> ...



I am not saying that pt's live all because of us, You my friend are reading more into it than what is there. Let me explain this, we are on mutual page with our ALS unit. We may not be able to intubate, but hey that is why we are all trained on King tubes N Combi's, AMI's we may not have advanced meds but we carry ASA and nitro, which would be medics first line. Whining about the classes being hard,,,,,uhm NO! not hard enough. But W/E.


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## Ridryder911 (Mar 29, 2009)

I am glad to see this but why don't your community deserve ALS first before an BLS unit? Why should even those exist except in the very remote areas? 

R/ r911


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## ffemt8978 (Mar 29, 2009)

AJ Hidell said:


> You also take jobs away from people with professional commitment who would like to devote to EMS as a career.  You also deny your community full-time professional coverage.  You also prevent educational levels from progressing.  Thanks for taking all that "very seriously".  You're my hero.



You're assuming that there would be a job created/available if there weren't volunteers, and assuming that there would be funding for it, and assuming the community wants full-time professional coverage.  Mighty big assumptions there.


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## Sasha (Mar 29, 2009)

EMTWintz said:


> AMI's we may not have advanced meds but we carry ASA and nitro, which would be medics first line.



First line, but not the entire treatment. Do you know the whys and hows, and why nots?

What other drugs do you carry? ALS has a big drug box for many different medical problems. EMS is NOT all about chest pain.


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## medic417 (Mar 29, 2009)

ffemt8978 said:


> You're assuming that there would be a job created/available if there weren't volunteers, and assuming that there would be funding for it, and assuming the community wants full-time professional coverage.  Mighty big assumptions there.



So far every community I have seen where all the volunteers quit has gone paid and this is in a poverty stricken area.  As soon as the local blue hairs (old women) start screaming about things politicians change priority's and money is found.  

Secret is you don't walk away quietly.  You post letters explaining why you can no longer volunteer, you emphasize the importance of having professional EMS including listing how it will be better, you emphasize the danger the community faces if left uncovered or relying on the mutual aid that may get withdrawn if there is no service at all in the the area, etc, etc.  It really is not hard.


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## ffemt8978 (Mar 29, 2009)

Ridryder911 said:


> I used to say ignorance was blessed.. but this borders upon stupidity. Please tell me about the aspiration pneumonia patient that died because you were unable to intubate and secure their airway, or the life threatening AMI that was increasing infarct size or the patient with pain and you could not administer an analgesic. Now, what exactly will you a ..."God send".. going to do for that premi birth?  Are you preventing those brain cells from dying due to hypoglycemia? I wonder how your community would feel if they knew they could provide almost the same care with a Boy Scout first aid course? God send? Yes, first aid is essential but please, please don't disguise yourself as medical providers.
> 
> Better quit patting yourself on the back before you need to call a Paramedic to administer pain med.'s..
> 
> ...



And let me ask you this?  What about the communities that refuse to support/fund an all paid-professional ALS system?  We can educate all we want, but it is ultimately the community we serve that has the final say in what level of care they want present.  If they say no to ALS, then what?  No EMS coverage at all?

Our county seat had a city FD that was running an all paid-professional ALS ambulance.  About three years ago, they disbanded the entire unit because the community refused to fund it to necessary levels.  They now contract with a neighboring fire district to provide their ambulance service.  Wait times for an ALS ambulance can be as high as 30 minutes now because this neighboring district is the only ambulance provider for 4 communities, and is the contracted ALS intercept provider for another 7 communities.


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## ffemt8978 (Mar 29, 2009)

medic417 said:


> So far every community I have seen where all the volunteers quit has gone paid and this is in a poverty stricken area.  As soon as the local blue hairs (old women) start screaming about things politicians change priority's and money is found.
> 
> Secret is you don't walk away quietly.  You post letters explaining why you can no longer volunteer, you emphasize the importance of having professional EMS including listing how it will be better, you emphasize the danger the community faces if left uncovered or relying on the mutual aid that may get withdrawn if there is no service at all in the the area, etc, etc.  It really is not hard.



See my response above where I quoted Rid.  The fire department in question did this, and it was a year long campaign for them to keep the EMS squad.  Ultimately, the voters voted their pocket book because contracting out was cheaper than keeping it in house.


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## medic417 (Mar 29, 2009)

ffemt8978 said:


> See my response above where I quoted Rid.  The fire department in question did this, and it was a year long campaign for them to keep the EMS squad.  Ultimately, the voters voted their pocket book because contracting out was cheaper than keeping it in house.



Well the citizens made their choice let them live with it.  But a little time and a few deaths waiting will get a change to take place.  Sad that people have to die but that is what some require.  If they are willing to accept this risk let them.


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## Sasha (Mar 29, 2009)

> Sad that people have to die but that is what some require. If they are willing to accept this risk let them.



This is something I have a problem with.

If we are in EMS for the patients, putting the patients first, are we really going to let people DIE to get what we want? Sounds kind of like spoiled children with hurt feelings, only you're playing with real people's lives.

I agree there's a need for paid, professional EMS. But I, personally, have a problem with sacrificing people's lives to get it.


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## EMTWintz (Mar 29, 2009)

Ridryder911 said:


> I am glad to see this but why don't your community deserve ALS first before an BLS unit? Why should even those exist except in the very remote areas?
> 
> R/ r911



We get there in a matter of min. our response time is 3min or less, where as it takes ALS 10-15min. And in some areas up to 30min.


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## EMTWintz (Mar 29, 2009)

Sasha said:


> First line, but not the entire treatment. Do you know the whys and hows, and why nots?
> 
> What other drugs do you carry? ALS has a big drug box for many different medical problems. EMS is NOT all about chest pain.



Well we def. dont get all the meds in the handy dandy drug box, but since you asked we get epi pen, neb tx's, ASA, nitro. For which all of us know the indications/contraindications and the fact that we have no problem calling med control before giving if we are unsure


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## AJ Hidell (Mar 29, 2009)

Sasha said:


> I agree there's a need for paid, professional EMS. But I, personally, have a problem with sacrificing people's lives to get it.


They're sacrificing their own lives if they ignore the problem until it's too late.  That burden is on them, not us.  It's the law of the jungle.  At some point, baby birds get kicked out of the nest and they either fly or die.  Occasionally some die.  I feel more compassion for the baby bird than people who are too stupid to protect themselves when they know the consequences.

I have yet to see a community that refused to provide some arrangement for EMS when the vollies dried up.  What I also have never seen is a volly squad work in earnest to eliminate their own organization in order to establish professional EMS in the community.  Instead, I see them fight it tooth and nail in order to save their little good ol' boys club.

And any system allowing non-paramedics to administer nitro is a system that sucks.


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## Veneficus (Mar 29, 2009)

medic417 said:


> Well the citizens made their choice let them live with it.  But a little time and a few deaths waiting will get a change to take place.  Sad that people have to die but that is what some require.  If they are willing to accept this risk let them.



Has there ever been a time that fire, EMS, or LE was not based on a management by disaster principle?

It is always after a death or serious event communities give any thought to funding these agencies appropriately.


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## medic417 (Mar 29, 2009)

Sasha said:


> This is something I have a problem with.
> 
> If we are in EMS for the patients, putting the patients first, are we really going to let people DIE to get what we want? Sounds kind of like spoiled children with hurt feelings, only you're playing with real people's lives.
> 
> I agree there's a need for paid, professional EMS. But I, personally, have a problem with sacrificing people's lives to get it.



It is wrong for them to ask me to do work for free.  Doctors let people die all the time because they can not get the money to fund the surgerys and treatments they need to prolong life.  Sorry that is harsh reality.  But in all honesty his community decided they did not need EMS so they choose to risk death who am I to try and stop it beyond trying to get them to change their minds.   If I am on duty I will be there but these people decided not to let them be on duty so they get sick and die its on them not EMS.  

This is not spoiled children this is people expecting lots for nothing.  I will not run as a volunteer but if they collapse next to me I would do chest compressions until the ambulance that they felt was safe to wait on gets there and pronounces them dead.  They made their bed let them die in it.


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## medic417 (Mar 29, 2009)

Veneficus said:


> Has there ever been a time that fire, EMS, or LE was not based on a management by disaster principle?
> 
> It is always after a death or serious event communities give any thought to funding these agencies appropriately.



Exactly after 9/11 money was free flowing for a year or two.  After someone important dies when ambulances are not available it becomes an issue and things improve for year or two.  Then people look and go wow those guys sleep in the parking lot a lot how about we cut funding because they do nothing but drive, eat and sleep.


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## Sasha (Mar 29, 2009)

EMTWintz said:


> Well we def. dont get all the meds in the handy dandy drug box, but since you asked we get epi pen, neb tx's, ASA, nitro. For which all of us know the indications/contraindications and the fact that we have no problem calling med control before giving if we are unsure



But do you know the whys and hows to how it works?


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## EMTWintz (Mar 29, 2009)

Sasha said:


> But do you know the whys and hows to how it works?



Nitro, when given to a pt with s/s of chest pain believed to be cardiac in nature will dilate the blood vessels in the body resulting in more blood staying in the veins and less blood coming back to heart which means the heart doesnt have to work as hard. Also drops the blood pressure, and ALS sometimes uses it to bring down dangerously high b/p's. Nitro dosage: .4mgs up to 3times pre-hosp.
Contraindications: Do not give if pt's systolic is close to 100. If b/p falls below but pt in trendelenberg; pt has head injury; pt is infant or child; pt has taken max dosage; pt has taken ED meds


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## EMTinNEPA (Mar 29, 2009)

Sasha said:


> This is something I have a problem with.
> 
> If we are in EMS for the patients, putting the patients first, are we really going to let people DIE to get what we want? Sounds kind of like spoiled children with hurt feelings, only you're playing with real people's lives.
> 
> I agree there's a need for paid, professional EMS. But I, personally, have a problem with sacrificing people's lives to get it.



Unfortunately, that isn't our call to make.  John Q. Public doesn't know anything about the lack of volunteers, the difference between EMTs and paramedics, the number of emergent calls a service runs daily, etc.

Lots of communities think that a volunteer ambulance will be enough.  If the town refuses to fund an ALS service, the ALS service has three choices that I can think of: 1) Go private, buy a lot more trucks, hire a lot more EMTs, and do a lot more IFTs, 2) Pick up a lot more territory to up their call volume, or 3) Call it a day.

I hate to sound like the folks on here that I argue with on a regular basis, but public education is the key.  John Q. Public needs to know more about how the EMS system works (or doesn't work) and what kind of wait times the community may be subjecting itself to by telling the paid service to take a hike because it will make their wallets fatter.  What can we do about it?

Volunteer paramedics?  As far as I know, no such thing.  Correct me if I'm wrong, but I believe you have to actually be on the clock at a professional ALS service to perform any ALS interventions because those interventions are an extension of your medical director's license to practice medicine.  Does John Q. Public know this?


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## EMTinNEPA (Mar 29, 2009)

EMTWintz said:


> Contraindications: Do not give if pt's systolic is close to 100. If b/p falls below but pt in trendelenberg; pt has head injury; pt is infant or child; pt has taken max dosage; pt has taken ED meds



Do you know why nitro is contraindicated in these situations?


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## enjoynz (Mar 29, 2009)

AJ Hidell said:


> And any system allowing non-paramedics to administer nitro is a system that sucks.



That is a very big statement to make! 
In fact there would be a very large percentage of EMS services in the world, that allow nitro to be given at an EMT-B skill level.
You telling us that EMS Clinical Directors throughout the world,
(who have years of experience and training in Field medicine that make that Clinical procedures) don't know what they are doing? 

Come on!!!!!

Enjoynz


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## EMTWintz (Mar 29, 2009)

EMTinNEPA said:


> Do you know why nitro is contraindicated in these situations?



You do not give nitro to pt with low bp, one word SHOCK. Do not give to pt with head injuries because risk of bleeding out (?). Its a no brainer why you don't give to infants and children. You just dont do it. If pt has taken ED meds their bp is probably already low and why lower it to the point of shock?


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## Ridryder911 (Mar 29, 2009)

EMTWintz said:


> Well we def. dont get all the meds in the handy dandy drug box, but since you asked we get epi pen, neb tx's, ASA, nitro. For which all of us know the indications/contraindications and the fact that we have no problem calling med control before giving if we are unsure



You do realize administering NTG without a knowing if the patient is having a right sided AMI could be fatal? Administering nebulizers to CHF instead of asthmatics can actually cause the patient more problems? There is a major difference between anaphylactic shock and a reaction.. right? 

Sorry, just because you have a box with some medications the patient might have on hand or already been prescribed does not make the difference, when in fact maybe harmful. Yet, again usually many do not understand this as they do not know medicine. 

R/r 911


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## EMTWintz (Mar 29, 2009)

Ridryder911 said:


> You do realize administering NTG without a knowing if the patient is having a right sided AMI could be fatal? Administering nebulizers to CHF instead of asthmatics can actually cause the patient more problems? There is a major difference between anaphylactic shock and a reaction.. right?
> 
> Sorry, just because you have a box with some medications the patient might have on hand or already been prescribed does not make the difference, when in fact maybe harmful. Yet, again usually many do not understand this as they do not know medicine.
> 
> R/r 911


and that is why we have taken the class and used our own research abilities to find out more about the meds we have been given. Again we are taking it upon our selves to increase our knowledge for the wellbeing of our pt's and community.


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## Veneficus (Mar 29, 2009)

EMTWintz said:


> Do not give if pt's systolic is close to 100. If b/p falls below but pt in trendelenberg; pt has head injury; pt is infant or child; pt has taken max dosage; pt has taken ED meds



Why 100 systolic? Are there times when it is below that it would be ok to? Who picked that number? 

The legendary Trendelenberg, might not have the effet you want. (or any at all)

Max dosage 3? I hope your transport time is less than 9-15 minutes.


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## EMTWintz (Mar 29, 2009)

Veneficus said:


> Why 100 systolic? Are there times when it is below that it would be ok to? Who picked that number?
> 
> The legendary Trendelenberg, might not have the effet you want. (or any at all)
> 
> Max dosage 3? I hope your transport time is less than 9-15 minutes.



100 is a number pulled outa someone's arse, Trendelenberg may not have the effect i want but what else am i gona do? As this is a BLS squad with ALS on their way.(which btw will take up to 10min.)


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## Veneficus (Mar 29, 2009)

EMTWintz said:


> 100 is a number pulled outa someone's arse,



There is some minimal thought behind it, but I would say you got the gist of it. 




EMTWintz said:


> Trendelenberg may not have the effect i want but what else am i gona do?



quite true, maybe dance around waving a dead chicken?  might have the same effect  might actually work better by scaring patient and the sympathetic response could increase bp.  




EMTWintz said:


> As this is a BLS squad with ALS on their way.(which btw will take up to 10min.)



Maybe you should alter the protocol for a few more unless the docs really like hearing your voice.


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## enjoynz (Mar 29, 2009)

Ridryder911 said:


> You do realize administering NTG without a knowing if the patient is having a right sided AMI could be fatal? Administering nebulizers to CHF instead of asthmatics can actually cause the patient more problems? There is a major difference between anaphylactic shock and a reaction.. right?
> 
> Sorry, just because you have a box with some medications the patient might have on hand or already been prescribed does not make the difference, when in fact maybe harmful. Yet, again usually many do not understand this as they do not know medicine.
> 
> R/r 911




Sorry Rid, but it could also be said for a medic that gives adreniline to a LQTS patient in arrest...
which I know is part of their procedures in codes here in NZ.
I can't say for the States, but I guess it would be one of the drugs used. 
Sometimes it's guess work for all skill levels....you do the best that you can at the time with the information you have at that time.
eg. Patient Medical History, Medic Alerts, etc.
People die every day because the medical profession doesn't have all the facts or answers.........even in hospitals.
I would have thought if there were that many deaths caused by an EMT-B giving cardiac patients Nitro,
the powers that be, would have taken that drug off their Code of practice years ago?

Enjoynz


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## Veneficus (Mar 29, 2009)

enjoynz said:


> Sorry Rid, but it could also be said for a medic that gives adreniline to a LQTS patient in arrest.
> which I know is part of their procedures in codes here in NZ.
> I can't say for the States, but I guess it would be one of the drugs used.



Not that RId needs me to answer for him, as he is quite smart, but since i am just hanging around...

In resuscitative medicine the guidlines for epi in an arrest is based on an unknown cause. Unfortunately many medics think these guidlines are the word of God and if there is a save, it was because of this. They lack in both critical thinking and medical knowledge.

In any arrest, if you put forth some effort in finding the cause, treating that cause is the best solution. If I suspected LQTS, as you have seen, mag is my candy of choice.

Epidemiology needs to be considered in all arrests of unknown origin, but no effort is paid to that in medic school or even at the hospital level sometimes.



enjoynz said:


> Sometimes it's guess work for all skill levels....you do the best that you can at the time with the information you have at that time.
> eg. Patient Medical History, Medic Alerts, etc.
> People die every day because the medical profession doesn't have all the facts or answers.........even in hospitals.



But there can be good guesses and no effort at guessing. There is a lot of inconsistency and especially prehospital, even if you do make a guess, you may not have anything to tret with.




enjoynz said:


> I would have thought if there were that many deaths caused by an EMT-B giving cardiac patients Nitro,
> the powers that be, would have taken that drug off their Code of practice years ago?



This arguement is an endless loop. If you don't give the nitro you are doing nothing, if you give it, you might cause harm. Do you stand and watch somebody deteriorate or make an effort that might harm? We have debated for years, there are no answers.


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## Foxbat (Mar 29, 2009)

AJ Hidell said:


> What I also have never seen is a volly squad work in earnest to eliminate their own organization in order to establish professional EMS in the community


My department used to be an all-volunteer agency, but now we have paid staff 24/7.
Or do you mean we have to prohibit volunteers altogether - as a 3rd person, or to staff additional trucks in case of MCI/multiple calls? That, indeed, will probably not happen anytime soon.


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## Foxbat (Mar 29, 2009)

EMTinNEPA said:


> Volunteer paramedics?  As far as I know, no such thing.  Correct me if I'm wrong


You are wrong. There are volunteer paramedics in my area.


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## AJ Hidell (Mar 29, 2009)

Foxbat said:


> My department used to be an all-volunteer agency, but now we have paid staff 24/7.
> Or do you mean we have to prohibit volunteers altogether - as a 3rd person, or to staff additional trucks in case of MCI/multiple calls? That, indeed, will probably not happen anytime soon.


What I meant was that I have never seen a volunteer organization actually campaign and work to get the community to support a full-time, paid career department, eliminating the volunteers department.  Just never seen it happen.  I have, however, many times seen volunteers fighting the take over by a paid department because they don't want to lose their little hobby.  After all, they spent lot of money on all those LEDs on their POVs.  They don't want to have to take them off!


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## fortsmithman (Mar 29, 2009)

AJ Hidell said:


> What I meant was that I have never seen a volunteer organization actually campaign and work to get the community to support a full-time, paid career department, eliminating the volunteers department.  Just never seen it happen.  I have, however, many times seen volunteers fighting the take over by a paid department because they don't want to lose their little hobby.  After all, they spent lot of money on all those LEDs on their POVs.  They don't want to have to take them off!



Currently my service is paid on call.  I would really like it if the town changed us from paid on call to full time and hired the current members because nearly all the members of my service would quit our regular jobs and go full time.  Only 3 members of my service have lights on their POVs.  I wouldn't because if one gets into an accident while responding with the POV emergency lights.   The insurance carrier my decline the claim and the member would have to pay any damages out of their pockets.


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## Foxbat (Mar 29, 2009)

AJ Hidell said:


> What I meant was that I have never seen a volunteer organization actually campaign and work to get the community to support a full-time, paid career department, eliminating the volunteers department.


And how will our residents benefit if we all walk out?
Let us also look at our neighbors' department. Unlike us, they are all volunteer (except one administrative member). Yet they are ALS and staff their truck 24/7. How will their community benefit if they no longer exist?


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## fortsmithman (Mar 29, 2009)

Having a paid full time service with a volunteer division.  It could work use the volunteer division to hire full time members when openings come up that could work.


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## Ridryder911 (Mar 29, 2009)

Foxbat said:


> And how will our residents benefit if we all walk out?
> Let us also look at our neighbors' department. Unlike us, they are all volunteer (except one administrative member). Yet they are ALS and staff their truck 24/7. How will their community benefit if they no longer exist?



Simple, you have will control on the quality of care. You are saying each of those ALS members are graduates of a degree program? .... 
Yeah, I didn't think so. 

R/r 911


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## Foxbat (Mar 29, 2009)

Ridryder911 said:


> You are saying each of those ALS members are graduates of a degree program?


Is every career medic graduate of a degree program?


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