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#21 Speed

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Posted 27 December 2009 - 09:28 PM

OK, you figured me out. I confess that I am part of a dark underground conspiracy against RN's and RT's, oh and paramedics too of course. It's part of a larger scheme you see... In 1972 a crack commando unit was sent to prison my military court for a crime they didn't commit. These men promptly escaped from a maximum security stockade in the Los Angeles underground. Today still wanted by the government they survive as soldiers of fortune. If you have a problem, and no one else can help, and if you can find them. Maybe you can hire the A-team. Blah...
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Mike Williams CCEMT-P/FP-C

#22 TexRNmedic

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Posted 27 December 2009 - 10:43 PM

Currently, in my agency we are using the Auto vent 4000 with CPAP. Our protocol to use CPAP requires our patients to have a Spo2 of less than 90% on a Non-rebreather. My personal opinion is that Spo2 is a very unreliable numeric value that has many variables that can affect the value. Example: CO poisoning will show a 100% reading with a good waveform. The main reason I am asking is that I had a patient recently in left sided heart failure where I was unable to obtain access as well as another medic. We auscultated rales in the lower lobes bilaterally. The patient was tachypneic with a respiratory rate of 34 and shallow. The patient was hypertensive with a blood pressure 178/72, SPo2 94%, and EtCo2 38. Without IV access, we treated with nitroglycerin and Albuterol. I wanted to do CPAP, however, our protocols only permit us to use CPAP with the patient with a Spo2 under 90% on a Non-rebreather. Will do well in patients with heart failure by increasing the pressure in the alveoli and pushing the fluid back into the circulation out of the alveolar-capillary membrane. I am aware that CPAP will decrease cardiac output by increasing pressure the chest. Being that the pressure in the chest is normally negative. In my opinion, this patient was well suited for CPAP, and without IV access to give lasix or morphine. Overall, I am looking to try to give my Operating Medical Director some recommendations in changing our protocol. Mind you that we are both suburban and rural with transports up to an hour to get to the hospital. Any help is greatly appreciated!


Travis,
I commend you on educating yourself and seeking the advice of others in the EMS profession. I was drawn to FlightWeb looking to benefit from the experience and intelligence of my peers in the EMS and critical care arenas. There are many great folks around here to learn from. Unfortunately, some folks take the “beat you over the head” and “eat our own young” mentality. Some of the best educators I’ve worked with have the ability to hold the students attention, teach them something and develop their confidence WITHOUT exuding a high and mighty attitude and raking the students over the coals for not somehow instinctively already knowing everything that took the instructor many years of hard work to learn.

From what you have posted, I agree with others that your protocols may need some tweaking in order to provide the best patient care. As others have said, NIPPV is not always the magic bullet that will fix the patient every time. It is better to have a broad arsenal of knowledge and skills available to choose the best therapy for the situation. Look for training in and outside of your employer for skills such as 12 lead analysis, advanced airway management, vascular access, pharmacology and pathophysiology.

Not knowing the dynamics of your department and mentality of your MD, I can’t give the best insight on how to approach protocol change in your specific department. However, I can tell you that there are few good ways to effect a change in any EMS organization. Talk with your Field Training Officers, senior in-charges, supervisors etc and see how they interpret the protocol(s) in question and discuss if the protocol can be improved to provide better patient care. These folks will typically have better access to medical control and the MD and will have the best chance of making a change. I see you are in EMT-P school. Talk to your instructors. They probably have some of the best insight into the local services, medical direction and protocols. Take a look at some of the big departments near there (Washington DC etc.)and see what they are doing. Hopefully you are doing your clinical ride-alongs with services other than your employer. Take a look at their protocols and discuss them with the crew. Be careful to not come across negatively about any protocol, employer or medical director. EMS is often a small community and you will probably be working with or for these folks in the future.

Best of luck in school and keep up the work on developing your knowledge and critical thinking skills.
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Wes Seale
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#23 old school

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Posted 27 December 2009 - 10:57 PM

Sorry, FloridaMedic, you and I agree on much but you are off the rails on this one.

So in essence you are saying just keep the bar low for Paramedics so they can continue with protocols that give them recipes by numbers instead of clinical judgement?

No one has even remotely done this in this discussion. The participants in this thread are actually some of the more pro-paramedic people on this forum.

It is not practical to teach a course in hemodynamics on this forum, as you alluded to yourself. While not 100% technically correct, in the interest of practicality and brevity it is not entirely inappropriate or inaccurate to describe CPAP (for the purposes of prehospital cardiogenic pulmonary edema management) as "forcing fluid back across the alveolar-capillary membrane". In fact the educational literature provided by a well-known respiratory care equipment manufacturer describes it as exactly that, and it is one of the first things that comes up on a Google search for "CPAP in pulmonary edema". So perhaps the OP was misled precisely because he was trying to educate himself.

Enough with the poor pitiful Paramedic crap where kid gloves have to be used because we don't want to hurt their feelings. Accept some responsibility for your own education and especially when your medical director wants to trust you with some new equipment or protocol. Don't just expect a recipe by the numbers.


No one has done this either. The OP isn't even a freakin' paramedic yet - give him a damn break! I agree 100% with you on the sad state of paramedic education (and, in turn, paramedicine), but do not whip a guy who is only halfway through his paramedic program because of it. He came here with a basic yet pretty intelligent question, asking for advice on how to IMPROVE his clinical capabilities. Your reply to him was condescending and rude, as is so often the case.
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#24 FloridaMedic

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Posted 28 December 2009 - 12:40 AM

Sorry, FloridaMedic, you and I agree on much but you are off the rails on this one.


No one has even remotely done this in this discussion. The participants in this thread are actually some of the more pro-paramedic people on this forum.

It is not practical to teach a course in hemodynamics on this forum, as you alluded to yourself. While not 100% technically correct, in the interest of practicality and brevity it is not entirely inappropriate or inaccurate to describe CPAP (for the purposes of prehospital cardiogenic pulmonary edema management) as "forcing fluid back across the alveolar-capillary membrane". In fact the educational literature provided by a well-known respiratory care equipment manufacturer describes it as exactly that, and it is one of the first things that comes up on a Google search for "CPAP in pulmonary edema". So perhaps the OP was misled precisely because he was trying to educate himself.


You're kidding? Right? Google said so? No reference? Did you happen to notice if it was "talking to EMS providers" on "google" cos you know how we have to "dumb" it down for them? I guess all that hemodynamic stuff about preload and afterload is just a bunch of bullshit.

No one has done this either. The OP isn't even a freakin' paramedic yet - give him a damn break! I agree 100% with you on the sad state of paramedic education (and, in turn, paramedicine), but do not whip a guy who is only halfway through his paramedic program because of it. He came here with a basic yet pretty intelligent question, asking for advice on how to IMPROVE his clinical capabilities. Your reply to him was condescending and rude, as is so often the case.


Is he working as an EMT-B or EMT-I for a BLS or ALS company?

Does that still excuse one for not knowing a few basics about their equipment?

What about his medical director? Has he approached him/her? Does his medical director even take part in his continuing education? Does his medical director not know how protocols are formed?

Why do we always defend the lowest denominator in EMS? EMT-Bs also do ETI so they don't get their feelings hurt. We have 50 different levels all differing by just a skill or two so no one gets their feelings hurt or feels left out. Imagine how many levels nursing or RT could have if they were worried about hurting someone's feeling by making them go through a whole two years of college.

But, this still falls into the hands and license of the OP's medical director. YOU do not write his protocols and do not know anything about his abilities or why he has not discussed the possibilities of CPAP with his medical director.

It is irresponsible to tell people to do things without knowing anything about their state, agency or medical director. However, just maybe if the guy has his ducks in a row when it came to understanding some of the fundamentals of CPAP he might appear more credible in front of his medical director rather than just handing him/her some "borrowed" protocol or information from an anonymous forum.

It is time for some in EMS to take note of their responsibilty to the patients and the public they serve. Their medical directors should hold some more accountable and if the OP's medical director doesn't agree that an EMT-B or I is ready for more indepth protocols then it is up to the OP to prove that is incorrect. He shouldn't whine about too much education which will really discredit him in front of his medical director and definitely show he is not ready for the next step. Should he realistically expect his medical director to bow down because some dude on an anonymous forum said so? Shouldn't there be some expectations met first or at least find out where the medical director stands with allowing EMT-Bs and Is do more?

Just maybe my comments might stop him from looking like an idiot when he does finally find the protocols he is looking for on the internet. That is, if he prepares for some of the same questions I just presented. But then, you might think those questions are too hard for him. If one wants the protocols and the equipment, they have to step up and take some responsibility.

Some of your remarks really do an injustice to the Paramedics who do take their careers, education and providing quality patient care seriously. They are the ones who don't whine about their medical directors expecting too much of them when it comes to accountability and having the knowledge/education to advance their protocols.

Frankly I don't care what you think either and I doubt if we ever agreed on anything. I am not for giving out skills to EMT-Bs and Is who do not have the education and for the most part, that should be Paramedic at least. These inbetween sorta like a medic levels need to go away. And, at least the EMT-I will soon vanish.

The new levels for EMS will go into effect with or without you. You can fight them but EMS will start to move forward. Hopefully those who want to treat EMS as a non-profession or just an ego trip which has nothing to do with patient care will fall off the map. It is time we stop babying those in EMS and get them up to par with the skills given so to them without asking for much experience, education or accountability to go with them.

Could it be the OP's medical director is also awaiting the new levels to see where the chips will fall?
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#25 BackcountryMedic

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Posted 28 December 2009 - 01:01 AM

The old FloridaMedic returns. You should really take your vitriol and police your own. There is plenty in nursing that is F'ed up. Go there and clean your own house first. Leave it to Speed, JLP, MacGyver and I to clean up paramedicine. You are not helping, in fact your holding us back. We don't need you. Bye bye.

Other then FloridaMedics crap, this is a good discussion. I hope it helps the OP. If he keeps asking good questions like this I think he will make a great medic.
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#26 old school

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Posted 28 December 2009 - 01:29 AM

FloridaMedic,

I briefly considered replying to you point-by-point again, but I know that you can never be proven wrong, so there is simply no reason to dispute anything you write.

Suffice it to say that YOU are not nearly the advocate that you tout yourself as being.


Disagreement is, of course, fine....necessary, even....we all realize this. But YOU consistently insult and demean others just because they don't see things quite the way you do. You also intentionally misrepresent things written by others, when the original statements are available in black and white on the very same page as your lies.


You are mean and you are an embarrassment to those of us who are real advocates for the paramedic profession. The fact that standards are not what they should be does not make it productive or right for you to demean a student who asks for advice, or those who attempt to provide some.


I know, I know....you couldn't care less what I or any other individual thinks of you, but when the opinion of YOU is pretty much universal, it might serve you well to take notice.

What's that saying....when YOU think everyone else is an idiot, you might re-think who the real idiot is....?
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#27 TexRNmedic

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Posted 28 December 2009 - 05:55 AM

FloridaMedic,

I briefly considered replying to you point-by-point again, but I know that you can never be proven wrong, so there is simply no reason to dispute anything you write.

Suffice it to say that YOU are not nearly the advocate that you tout yourself as being.


Disagreement is, of course, fine....necessary, even....we all realize this. But YOU consistently insult and demean others just because they don't see things quite the way you do. You also intentionally misrepresent things written by others, when the original statements are available in black and white on the very same page as your lies.


You are mean and you are an embarrassment to those of us who are real advocates for the paramedic profession. The fact that standards are not what they should be does not make it productive or right for you to demean a student who asks for advice, or those who attempt to provide some.


I know, I know....you couldn't care less what I or any other individual thinks of you, but when the opinion of YOU is pretty much universal, it might serve you well to take notice.

What's that saying....when YOU think everyone else is an idiot, you might re-think who the real idiot is....?


FloridaMedic,

Here is the following for you including reference sited!

Ways of addressing conflict
Five basic ways of addressing conflict were identified by Thomas and Kilman in 1976:


Accommodation – surrender one's own needs and wishes to accommodate the other party. Obviously not your style.

Avoidance – avoid or postpone conflict by ignoring it, changing the subject, etc. Avoidance can be useful as a temporary measure to buy time or as an expedient means of dealing with very minor, non-recurring conflicts. In more severe cases, conflict avoidance can involve severing a relationship or leaving a group. Again probably not your style but might occasionally work for you.

Collaboration – work together to find a mutually beneficial solution. While the Thomas Kilman grid views collaboration as the only win-win solution to conflict, collaboration can also be time-intensive and inappropriate when there is not enough trust, respect or communication among participants for collaboration to occur.

Compromise – bring the problem into the open and have the third person present. The aim of conflict resolution is to reach agreement and most often this will mean compromise.

Competition – assert one's viewpoint at the potential expense of another. It can be useful when achieving one's objectives outweighs one's concern for the relationship. Seems to be your style and and IMHO not a very successful one

Although a newer poster on FlightWeb, I still have the same desire as the other more seasoned posters in this thread, in that I want a place to have intelligent and educational conversations that promote and develop the critical care transport arena. What I've read from you often seems to be hostile, especially towards the newer and less experienced provider. Thread hijacking with personal agendas outside the scope of the original post does little to motivate new arrivals to the forum or promote the CCT profession. I'm sure others agree that although you surely know your trade, you come across burned out and bitter. Please move your filibustering to a tête-à-tête utilizing the private message function.
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Wes Seale
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#28 TexRNmedic

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Posted 28 December 2009 - 06:16 AM

...And to clarify, I'm more of a collaboration kind of guy. So please direct your private message dissertations to those on here with the time, desire and most importantly patience to lock horns with you. Thanks and I hope you have a blessed week!
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Wes Seale
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#29 Gila

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Posted 28 December 2009 - 06:38 AM

Oh boy. OP, I hope you found some of what you were looking for.
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#30 FloridaMedic

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Posted 28 December 2009 - 11:45 AM

The old FloridaMedic returns. You should really take your vitriol and police your own. There is plenty in nursing that is F'ed up. Go there and clean your own house first. Leave it to Speed, JLP, MacGyver and I to clean up paramedicine. You are not helping, in fact your holding us back. We don't need you. Bye bye.

Other then FloridaMedics crap, this is a good discussion. I hope it helps the OP. If he keeps asking good questions like this I think he will make a great medic.

Oh yeah...that nasty education stuff keeps getting in the way.

Do you want to tell me exactly what you have done with the NREMT to get the new levels? How about at your state level? Some of us have actually been working to improve paramedicine despite those who think education is just a bunch of crap when you can do all those skills anyway. Nothing you say is anything new as others like you have already been pleading with the national and state organizations not to make them do any more "hours" of training as some believe the EMT-B and Paramedic are way too hard now. How dare I to want a Paramedic to actually know about a few disease processes and have an understanding about the meds and equipment!

Isn't it amazing what a Paramedic can do without having any clue as to what Pulmonary Edema, Left Heart Failure, Right Heart Failure, cardiac output, preload, afterload or the lymphatic system is? One can just "Google" up CPAP and see a dumbed down "pushing water out of the lungs". From that a Paramedic can use some really cool skills and meds.

So again, what national and state committees are you on...to prevent Paramedicine from moving forward?
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#31 ST RN/PM

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Posted 28 December 2009 - 12:00 PM

Hey Florida,
As I stated in my first post, there are ways to help others. Travis is trying to make things better in his organization....ie.....RAISE THE BAR HIGHER. You may not be part of an organization that holds the keys to the kingdom very tightly, but when it happens or when it "is what it is"......IT SUCKS. It sucks bacause you have bright guys like Travis who are attempting to learn more and practice safe medicine and advocate for their patients who continually have their hands tied, and are reaching out on this forum, because on this forum are some of the best and brightest. Please, instead of demeaning those on this thread.... try to help them. I myself am an RN first, a paramedic second..... having seen and lived in both worlds, I understand what he is going through. The agency where I work as a prehospital ALS provider on the ground.....we still don't have RSI for our patients.... and we only have just started to get appropriate medications for BP reduction in hypertensive crisis, nausea prophylaxis, ....
So many times in the past, I was forced to "use what I had" and try to adequately and quickly sedate a patient to try and achieve ideal intubation conditions using Morphine and Midazolam.....sometimes, that just doesnt cut it. Travis is looking to Flightweb to learn from others experiences. Either try to help him, or just stay off of the forum.
Travis is doing just what you said he wasnt.....attempting to try and accept some responsibility for his education. I am not saying any "poor pitiful paramedic crap" as you say.... that was not the point of my post at all, and frankly, I, and apparently other posters are sick of your vitriol. If putting others beneath you makes you happy, this is not the place for it. To all other posters, thanks for echoing my sentiments. At the end of the day, I hate arguing on a public forum and bashing others, but Florida makes me crazy with the way she brings her cumulative discontent with EMS, RN VS Paramedic VS RRT, and other issues.
Travis, keep reading and learning. I do not have any words of wisdom except these: if you present a good argument to your Medical Director using evidence based medicine as your podium, you may find success. Keep at it! I have been going through this at my own Ground-only 911 medic agency, and keep meeting up with roadblocks.....but in a year and a half, our agency switched from Combis to Kings, we got Etomidate for Drug-Assisted intubation......see my point...? Baby steps, but steps in the right direction.... and evidence based medicine was the Ace-in-our-sleeve. Good luck all,
Florida, please stop trying to best everyone, and do what a very smart colleague of mine told me once......"Don't just do something..... stand there".....stand here and listen to how other posters describe your threads and see what is being said rather than instantly respond with defensive and simultaneously offensive posts.
We don't know you and I myself don't take what you say personally. I just would like to foster and maintain a positive attitude on this forum, and help those that are looking to the forum for professional advice. We do not need to eat our young.
Peace, Steve
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Steve T. RN, PM

#32 FloridaMedic

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Posted 28 December 2009 - 12:04 PM

Although a newer poster on FlightWeb, I still have the same desire as the other more seasoned posters in this thread, in that I want a place to have intelligent and educational conversations that promote and develop the critical care transport arena. What I've read from you often seems to be hostile, especially towards the newer and less experienced provider. Thread hijacking with personal agendas outside the scope of the original post does little to motivate new arrivals to the forum or promote the CCT profession. I'm sure others agree that although you surely know your trade, you come across burned out and bitter. Please move your filibustering to a tête-à-tête utilizing the private message function.


And what have you done for EMS at the national or state level? Texas still only requires a mere 624 hours of training to be a Paramedic. EMT-Bs are allowed to intubate in your state. It probably won't be long before thay can do RSI with their 120 hours of training. Do you see where EMS has been going? As long as it is in the "scope" no education or training or medical director is required?

Some try to pass themselves off as "CCT" or "Flight" but yet can not give a decent description about CPAP to an EMT-I. But, some do want to come off as knowing more than the OP's medical director.

Yeah, I burnt out but not from patient care. It is from trying to get Paramedicine to an educated level and am sick of excuses from those who are too lazy to get an education to even understand what pulmonary edema is. Listening to the whining about not wanting the hardship of education is really tiring. Some seem to forget there are patients involved when they selfishly want their own ego agendas fulfilled.

So again, what national and state committees are you on?

This used to be a decent forum with many educated Paramedics, RNs and RRTs but no more. It is just the usual "we don't need none of that book learnin' stuff".

Surf up NIPPV, CPAP and Ventilators from the 2007 posts on this forum. You will see very different people there and the discussions are at an intellectual level.

And for those who want to "google", at least use "Google Scholar" to get better literature if you don't want to go on an actual medical search engine like medscape which is easily available but WARNING, it contains medical information.


To the OP, open up the lines of communication with your medical director. Don't just hand him/her some protocol you pulled off the internet on an anonymous forum. Network with the agencies around you. Attend a state seminar or education committee meeting to see what the leaders and educators of EMS in your area have to offer.
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#33 FloridaMedic

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Posted 28 December 2009 - 12:08 PM

Hey Florida,
As I stated in my first post, there are ways to help others. Travis is trying to make things better in his organization....ie.....RAISE THE BAR HIGHER. You may not be part of an organization that holds the keys to the kingdom very tightly, but when it happens or when it "is what it is"......IT SUCKS. It sucks bacause you have bright guys like Travis who are attempting to learn more and practice safe medicine and advocate for their patients who continually have their hands tied, and are reaching out on this forum, because on this forum are some of the best and brightest. Please, instead of demeaning those on this thread.... try to help them. I myself am an RN first, a paramedic second..... having seen and lived in both worlds, I understand what he is going through. The agency where I work as a prehospital ALS provider on the ground.....we still don't have RSI for our patients.... and we only have just started to get appropriate medications for BP reduction in hypertensive crisis, nausea prophylaxis, ....
So many times in the past, I was forced to "use what I had" and try to adequately and quickly sedate a patient to try and achieve ideal intubation conditions using Morphine and Midazolam.....sometimes, that just doesnt cut it. Travis is looking to Flightweb to learn from others experiences. Either try to help him, or just stay off of the forum.
Travis is doing just what you said he wasnt.....attempting to try and accept some responsibility for his education. I am not saying any "poor pitiful paramedic crap" as you say.... that was not the point of my post at all, and frankly, I, and apparently other posters are sick of your vitriol. If putting others beneath you makes you happy, this is not the place for it. To all other posters, thanks for echoing my sentiments. At the end of the day, I hate arguing on a public forum and bashing others, but Florida makes me crazy with the way she brings her cumulative discontent with EMS, RN VS Paramedic VS RRT, and other issues.
Travis, keep reading and learning. I do not have any words of wisdom except these: if you present a good argument to your Medical Director using evidence based medicine as your podium, you may find success. Keep at it! I have been going through this at my own Ground-only 911 medic agency, and keep meeting up with roadblocks.....but in a year and a half, our agency switched from Combis to Kings, we got Etomidate for Drug-Assisted intubation......see my point...? Baby steps, but steps in the right direction.... and evidence based medicine was the Ace-in-our-sleeve. Good luck all,
Florida, please stop trying to best everyone, and do what a very smart colleague of mine told me once......"Don't just do something..... stand there".....stand here and listen to how other posters describe your threads and see what is being said rather than instantly respond with defensive and simultaneously offensive posts.
We don't know you and I myself don't take what you say personally. I just would like to foster and maintain a positive attitude on this forum, and help those that are looking to the forum for professional advice. We do not need to eat our young.
Peace, Steve


And what have you don't for Paramedicine at the local, state and national level?

Are you even aware of the changes or do you even care?

Why should EMS just be given skills without raising some accountability?

Do you think with your attitude that there are not several reasons why RSI is not in your toolbox?
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#34 BackcountryMedic

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Posted 28 December 2009 - 12:19 PM

I teach. I mentor. I set expectations. I encourage. I work at the local level, where I can have the biggest impact.

Occasionally, I'll lobby or comment on issues at the state level. I belong to some national organizations. I wish I could do more, but I do what I can. I've made a positive impact, but nothin' earth shattering. Just me pushing for quality patient care and setting the example.

Mostly I'm proud of past students that are growing in this profession. I'm not going to fix the worlds problems; I just do what I can.

I wish I could listen to you. You're a smart guy and really know your shit. But, I just don't have room in my life for your drama. Thankfully there are a lot of really smart people on this forum that can educate me.

Good luck tilting at windmills. You are failing. No one cares what you think. You will improve nothing.
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#35 FloridaMedic

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Posted 28 December 2009 - 12:36 PM

I teach. I mentor. I set expectations. I encourage. I work at the local level, where I can have the biggest impact.

Occasionally, I'll lobby or comment on issues at the state level. I belong to some national organizations. I wish I could do more, but I do what I can. I've made a positive impact, but nothin' earth shattering. Just me pushing for quality patient care and setting the example.

Mostly I'm proud of past students that are growing in this profession. I'm not going to fix the worlds problems; I just do what I can.

I wish I could listen to you. You're a smart guy and really know your shit. But, I just don't have room in my life for your drama. Thankfully there are a lot of really smart people on this forum that can educate me.

Good luck tilting at windmills. You are failing. No one cares what you think. You will improve nothing.


So why do you just continue to advocate for the lowest levels and handing out skills rather than education?

Are you opposing the changes?

Have you even looked at the new levels?

If you teach, do you want your students to know what Pulmonary Edema actually is or do you just say "lung water"?

Do you teach your students that "CPAP pushes lung water" to bypass all that education stuff?

Do you tell them "Lido numbs the heart to reduce irritability" so you don't have to teach pharmacology?

The teachers should be the ones held to a higher standard to get the bar raised so they don't continue teaching the above to their students.
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#36 BackcountryMedic

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Posted 28 December 2009 - 01:05 PM

So why do you just continue to advocate for the lowest levels and handing out skills rather than education? I don't. Why do assume I do?

Are you opposing the changes? Nope. I love it. Thrive on it. Welcome it.

Have you even looked at the new levels? Sure have.

If you teach, do you want your students to know what Pulmonary Edema actually is or do you just say "lung water"? I don't teach "lung water".

Do you teach your students that "CPAP pushes lung water" to bypass all that education stuff? Nope

Do you tell them "Lido numbs the heart to reduce irritability" so you don't have to teach pharmacology? Nope. Actually, I do my best to teach pharm, but it isn't my strong suit. I'm trying to grow in this area. I would never teach a straight pharm course. I frequently refer questions I can't answer to pharmacists I work with.

The teachers should be the ones held to a higher standard to get the bar raised so they don't continue teaching the above to their students. Yep they sure should.


Keep responding. You are embarrassing yourself.
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#37 FloridaMedic

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Posted 28 December 2009 - 03:02 PM

Keep responding. You are embarrassing yourself.


No, embarrassing is having Paramedics who claim to work CCT and Flight that have no clue what CPAP is or does. Please enlighten us as to how the BP is affected with CPAP. Too much "water pushed from the lungs"?

If one has no clue about how CPAP works or the disease processes, you will be very limited to what patients you can use it on. If you do not know anything about the effects on the hemodynamics, you will be clueless as to what to expect with the different heart failures and the vitals.

Some really need to stop dumbing down Paramedicine especially since it seems to be filtering into the ranks that had once considered themselves as a higher level of care in CCT and Flight.
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#38 Gila

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Posted 28 December 2009 - 03:24 PM

Hey guys, this has absolutely nothing to do with the topic at hand?
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Christopher Bare
"Non fui, fui, non sum, non curo "

#39 Speed

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Posted 28 December 2009 - 03:45 PM

I think the guy should just bring in somebody from the local facility RT that has some respect and have a short re-fresher on NIPPV. Bring in the medical director for the last 30 minutes of it (let him be prepared) and have a discussion about changing the protocols. Look into getting an EZ-IO too.
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Mike Williams CCEMT-P/FP-C

#40 JLP

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Posted 28 December 2009 - 06:07 PM

So why do you just continue to advocate for the lowest levels and handing out skills rather than education?

Are you opposing the changes?

Have you even looked at the new levels?

If you teach, do you want your students to know what Pulmonary Edema actually is or do you just say "lung water"?

Do you teach your students that "CPAP pushes lung water" to bypass all that education stuff?

Do you tell them "Lido numbs the heart to reduce irritability" so you don't have to teach pharmacology?

The teachers should be the ones held to a higher standard to get the bar raised so they don't continue teaching the above to their students.



This is becoming increasingly pointless. FloridaMedic, I have no doubt that you know your stuff very well - better than I do on much of the material in question here. That is not the issue. I am in firm agreement front-line EMS education is often still pretty dismal, and that transport providers, be they paramedics, RN, RT or some combination, need to be genuinely well educated. To become a critical care paramedic in my system takes about five years IF all the stars lined up for you; it's usually longer. I do not teach any of the shortcuts you mention above to flight paramedic students. However, you have to tailor teaching to the student; if you want students to become more advanced, you can't expect them to step to your level in one go; you have to start where they are and where they can go right now, then help them work there way up. Talking over peoples heads, browbeating them, or engaging in personal slag-fests, well, it just wastes the time and the opportunity for learning is lost. I enjoying reading your tips and I'd sure enjoy the chance to pick your brain for a while if I ever got the chance to work with you, but the snarliness just turns people off. When you or Pink or Speed start going at each other personally, I just stop reading, so the knowledge you could legitimately pass on just goes in the great cyber-trash can. Can I suggest that everyone take a breath and let the next opportunity to slag someone pass by, so that maybe OP and the rest of us could go back to actually learning.

By the way, I have no illusions that I am fixing EMS or transport medicine in any way. I've just been lucky enough to learn from great people, and I'd like to help pass that on to other people who would like to learn. I am here to learn from you all as much as OP is.
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