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Tricyclic overdoses should be lavage as well, and yes bicarb if possible. There is was an article that described a 50/50 rule. Fifty percent of the patients that present with tricylic poisoning are asymptomatic, and 50% of those die...(sorry, can not find the article) This type of overdose is one of the most serious types around, when many are concerned with Valium, Lortab etc.. which does not cause as much toxic effects.
So being over cautious is good advise on tricyclic O.D.'s. The patient may appear okay, and in a few minutes be dead. Idioventricular rhythms are prominent in many of the O.D.'s
In our state Intermediates are able to administer NaHc03 (and D50W as well) due to it is considered an electrolyte solution not a medication (according to the State Medical Director). Most of the EMT/I's in my state are in rural areas, EMT/I's in metro areas are usually EVO's. Basic's and Intermediates are generally considered the same here. As well most of the EMT/I courses are no longer taught.. either Basic or Paramedic.
R/r 911
Very good points made Ridryder.
As far as Basic classes, I think they should just do away with the Basic program all together. I think it is just a waiste of time. I mean if someone is going to be an EMS provider, why not go ahead and be a real provider. Paramedic is the only way to go. Don't you agree?
I too think there's a place for emt-b, example, first responders (firefighters), bls routine transport, etc. I would even consider emt-b in ems in certain circumstances. I just think we should get away from our reliance on poorly trained bls providers to provide a primary ems service. As for emt-I/emt-c, that's just a poor, cheap, lazy mans paramedic (not a knock to every emt-I, there are some good ones).
LA County has a Medic on virtually every ambulance and fire engine... and their medics supposedly get an average of 2-3 tubes a year... so, no wonder they SUCK at intubations. Boston EMS has *something like* 70 medics on the payroll - similar cities have that many medics on the street on a shift - and Boston gets WAY more Code Saves than a city like Philadelphia, with 80 medics on duirng peak hours.Damn, what a can of worms this is! I work in a larger community/county, about 50k ppl in winter and 250k ppl in summer. We have a level 4 community hosp in town, and are 62 mi from a lvl 2 trauma cntr, 132 miles from the cities which has a couple lvl 1's and specialty centers. our trucks staff 1 EMT-I, 1 CCNREMTP. I call our good emt-I's "mini-medics" becuase we hold them to a very high standard, and most of the meet & surpass the expectations. When there is a lot of stuff to be done, and we need to leave scene RFN due to a 30min code 3 time, I love the help in the back, we get set up, I do the rest enroute. Now even considering our run volume is 89% ALS, It would be a finiancial nightmare to staff all medics. EMT's have their place and serve it well. Someone on here has a tagline that reads "The EMT you teach today is the Paramedic who may take care of you tommorow". That is a great mentality, one I try to take to work with me each day.
Ridryder cited a study saying "some larger services Paramedics may only intubate 3-4 times a year". I've done that many so far this year! I wonder what is behind this?
I think paramedics should be the only level allowed on a truck anyway.
I think EMT-I's are just taught enough about ALS to get them in trouble. They are in my book, Kindergarden ALS.... Medic want to be's!
200 calls that's it ? That's about 4 calls a week. Some would not even consider that is not enough exposure to maintain proficiently. Now, when you quit bragging, let's really evaluate how many "saves" you really did actually perform. You (yourself) can actually present and demonstrated that you prevented and actually cured and brought someone back from the dead? All this within 200 calls? Better publish your results, because the national average is <6%. It is hard to describe any medic or even an ER Doc that they will say that they save very many lives a year.
I never said that BLS was better than ALS. As for what I would do for those patients, I would load and go. 15L via NRB. Monitor and treat where possible (traction split and nitro are two examples.) Call for ALS. Run to the hospital like something was chasing me.You can actually say having BLS is better than providing ALS for your patients? What are you going to do when that patient has a right sided AMI, frank CHF, or even severe pain with that femur fracture or 60% burns with facial subglottic emphysema? We could list the potential problems that involves anything that requres medication(s) and monitoring of ECG and hemodynamic factors.
Four months while going to school and working. I am also on call for approx. 36 hrs/week. That's no small time committment. However, I do agree that two weeks is FAR too short. California needs to retool their EMT-B class if they can cram it all into two weeks.Now you described you gave a "great portion of your life" for a EMT certification. A few weeks of night school is a great portion of life ? Want to compare ? EMT courses are just a few weeks greater than the advanced first aid and the first responder courses. In fact in California, one can take a complete EMT course in 2 weeks. Even a manicurist goes an additional 50 hrs longer than the standard EMT course to learn to cut and polish toenails, and the beautician (that cuts dead cells) goes almost 200 hrs longer than the standard Paramedic course in the U.S. This is a shame ! No matter if one is volunteer or paid.
If any of those journals ever advocated for removing BLS providers from ambulances, I would love to see the article.Slander?.... This is not from just the poster or what you labeled as Paragods rather by publications from national renowned physicians and EMS researchers.(Wang, Bledsoe, Pep'e. etc) Those that actually gave up "decades" of their lives to study and understand EMS systems and emergency and critical care patient care.
I suggest that you might want to refer to medical journals such as Prehospital Care, Studies of Prehospital Disaster Medicine, Emergency Cardiac Care Quarterly, Journal of Trauma, ENA Journal, ASTNA Journal, and JEMS . Visit the web sites such as Advocates for EMS, National EMS Educators Society, National EMS Physicians, American College of Emergency Physicians, and American College of Surgeons, CAPEM,etc...
Health care professionals are concerned that the care being delivered is going downward, and the levels of training has become less and less efficient at all levels.
The concern should be for all levels and both paid and volunteer. If we do not improve it, someone (other than those in EMS) will.