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Opportunities, opportunities

October 23, 2012 Leave a comment

By: Michael Stanley

Right now, I’m in a job drawdown, from coordinating EMS classes, being an EMR/First Responder, and Intermediate to being a Paramedic.

U.S. Air Force

Stanley worked at an Air Force base in Abilene, TX.

For quite some time I have setup instructors, materials and texts to create military medics from all branches, but unfortunately there are smaller numbers due to budget cuts. Military training will be open to registration through NREMT and NAEMTS upon return to civilian EMS. This is more successful with military contractors and subcontractors and even federal law enforcements.

Specialized federal organizations and secretive groups use former military and new hires rather than regular military medics. I believe if you follow politics right now, there are some congressional reps. that are holding hearings on how we are retaining some excellently trained medics. Due to specialized military training, some medics cannot go out on a civilian ambulance.

When I was first assigned as a new medic in the Air Force to a west Texas base, I was assigned to the emergency room. We ran all on base and off base EMS calls. We even offered mutual aid for the city of Abilene. I selected this base as my first choice, because I had been a member of a volunteer junior rescue squad since age fifteen. This put me in line to go to the best unit in the hospital. We had two groups, and offered State of Texas EMS training starting at EMT, through the ranks to Paramedic. One group finished then the second group went through, at the Air Force’s expense. When not in class, we worked in the base hospital emergency department.

What better set up could we have had? It was awesome.

Translating EMT Concepts Between Cultures

August 16, 2012 5 comments

By: Grant Campbell

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Inaugural ambulance at hospital in Punjab, India.

Situated in the Himalayas of North India, we at Lady Willingdon Hospital are uniquely positioned at the forefront of emergency medical education in the region.  Due to this fact, we have found ourselves struggling to balance the dual needs of tackling the lack of adequate first responder services in the area while meeting our own requirements for highly skilled critical care Paramedics. 

So, do the tried and true methods of emergency medical education work in the Indian context?  Can we simply translate curriculum developed in the States into the local language?  Well, yes and no.

The typical use of oral boards and skills stations as a means of assessing skills competency, breadth and depth of knowledge is a much-needed enhancement to the way training is done.  But, on the other hand most of the people here have a great ability to make things work with whatever resources they have.  This is a key attribute of a good EMT anywhere and is not an easy thing to teach.

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Campbell’s students learn about ventilation.

Teaching in India, I have found that I don’t have to teach my students to work together.  It is a natural part of the culture.  But I do have to figure out ways to teach them to make the most efficient use of team members. 

I don’t have to tell them to think about remembering to document the medications used because they want to make sure the patient is billed.  But, I do have to encourage them to communicate more openly with the patients about what is happening to them and to get informed consent.

These are just a few examples of differences between teaching in the States and India.  We have certainly had to find new ways to ensure that critical concepts are learned but the information and skills necessary to assess and treat patients remains constant. 

The human body works the same in the United States as it does anywhere else. No matter where you find yourself, at the end of the day, no matter where you go, patients are patients and they all require and deserve the best care that can be afforded to them.

Categories: Uncategorized Tags: , , ,

Top Five Tips for New EMS/EMT Students

July 3, 2012 Leave a comment

We recently asked one of our Facebook followers (and fellow professionals) what advice they would give to rising professionals. Here is one response:

1. Stay cool, calm and collected.
2. Medical consultation is not a sign of weakness.
3. Be humble. Even if the criticism is not always constructive.
4. Take the good qualities from multiple people not just one. Everyone has something to offer even if it’s an example of how not to be.
5. Never stop learning, you have only scratched the surface when you first begin in the field.

List by: Kristina Brozenick

Categories: Uncategorized

Teaching Your Students New Oxygen Administration Techniques

May 24, 2012 Leave a comment
Dan LImmer

Photo Credit: EMSWebSummit

The way oxygen is administered has changed quite dramatically in the past few years. The old oxygen delivery theory of “everyone gets high concentration oxygen by non-rebreather” is clearly not the case anymore. The 2010 American Heart Association guidelines were a major reason for this change.

There are three major concepts explaining why practices have changed. Use these as a guide when making decisions about oxygen administration:

  • Oxygen is a drug. Like any drug, a patient may be given too little or too much. All other medications are given based on need and therapeutic benefit. We must keep this in mind as a fundamental concept in oxygen delivery.
  • Oxygen can cause harm. Current research indicates that oxygen can actually cause harm in reperfusion situations at the cellular level. In cases of heart attack and stroke, parts of the heart or brain are deprived of oxygen. As a result, toxic byproducts of this anaerobic metabolism build up in the cells. When perfusion is restored to these areas, oxygen reacts with free radicals and other substances causing significant damage at the cellular level and may even send these toxins to other parts of the body as well.  Although some cells will die as a result of the initial stroke or myocardial infarction, it is the surrounding cells that still have a chance to recover that are at greatest risk during reperfusion.
  • Oxygen should be administered based on your overall evaluation of the patient’s presentation and possible underlying conditions. Patients who have oxygen saturations below 94% and those who show signs of hypoxia or criticality (e.g. pale skin, altered mental status, cyanosis, difficulty breathing) should receive oxygen based on severity and in an effort to improve oxygen saturation. Don’t withhold oxygen from a patient in distress regardless of oxygen saturation readings. In a significant number of cases a nasal cannula will be enough to raise saturation and benefit the patient with less potential for causing harm.

Always remember to ventilate rather than oxygenate patients in respiratory failure or arrest. Apply oxygen to the BVM or pocket face mask while ventilating patients.

The 2010 American Heart Association guidelines deal with patients with acute coronary syndromes and stroke. Many however believe that the oxygen administration guidelines also have some application to trauma patients. If you had a patient with an isolated tibia and fibula fracture with no signs of shock or other injury and an adequate oxygen saturation, oxygen might not be necessary at all, or if administered, only with a nasal cannula. Similar to medical patients, trauma patients showing signs of hypoperfusion or hypoxia should still receive high concentration oxygen.

We recognize that these new guidelines will require solid patient assessment and clinical judgment when making decisions regarding oxygen—both in the field and on your examinations for certification. One thing appears clear however; the days of automatically administering high concentration oxygen by non-rebreather mask are over.

This blog post is a result of collaboration between Brady authors Dan Limmer, Mike O’Keefe, Ed Dickinson, M.D., and Joe Mistovich.

Categories: Uncategorized

Reflecting on 32 Years in the Industry, Remembering the Basics

April 26, 2012 Leave a comment

I began as an Emergency Room Technician in a small but very busy ER in 1980. If anyone remembers, there wasn’t even an Emergency Department back then.

I first went to EMT-B school in 1982 and I rode with some of the busiest ambulances and the best paramedics in Chicago. My biggest regret is that I never went to paramedic school but I could never see myself working for a private agency for barely any money just so they would sponsor me into school. I let my EMT license lapse and continued in the ED.Image

In the early 1990’s, I took another shot and went back to EMT-B school. But, again, I still wasn’t satisfied with what I was seeing from my friends in the private sector. I entered Nursing School in 1992 and the rest is history. I grabbed every certification and educational opportunity offered. But something was always missing.

I learned that certain something was the dream of teaching and writing about the medical field, especially EMS. Sixteen years passed and I found myself to be a “burned out” ER nurse.

A job opened up running a paramedic program and I jumped at it. I have to continue working in the ED every weekend because the salary of a paramedic instructor is less than stellar. So I work six days a week for twelve hours a day. I’m sure some of you can relate.

I’ve seen safety practices and departmental changes since I first started my career in 1980. In a sense, I know the best practices by experience and look for ways to teach these concepts. We use Brady’s updated Paramedic Care Principles and Practice textbook in my course. The textbook, workbook, instructor resource manual, and Course Compass have made it easier for my students and I to grasp difficult concepts that paramedics nowadays need to understand.

Because I teach paramedic school, my assessment skills are much better, my EKG reading and strip reading has greatly improved and I understand more of the pathophysiology that I was missing. Most importantly, my empathy was reborn.  Both careers augment each other and I love them both.

My 32-year career in such a demanding field has provided me with one realization: sometimes you need to get back to basics. Reflect on your time helping the injured, and remember why you chose this field.

Joseph J. Doweiko (RN, BSN, ECRN, TNS, LI) is an EMS Education Coordinator with Advocate Christ Medical Center in Chicago.

Categories: Uncategorized

Not Lost in Translation

March 28, 2012 Leave a comment

“Patients are patients. No matter where you go, don’t forget that.” Those were my Lieutenant’s words just before I left the states.

Ambulance in North India

Campbell uses ambulances like these to transport ill or injured North India citizens.

Now, her words rang in my ears as I stepped into the ER at a mission hospital in the majestic Himalayas of north India. The early days here were challenging.  All of the patient interviewing skills that had been drilled into my head in Paramedic school were thrown out the door because I couldn’t speak the language. I had to rely on my physical exam techniques: Inspection, Palpation, Auscultation… All of you can probably recite the mantras you memorized during your training.

But you know what? She was right. Yes, communication barriers can be a huge hindrance in treating patients, but if you stick to the fundamentals you will be OK and what’s more, your patients will fare better too.

How well you grasp the fundamentals is what defines you as a caregiver, so that is what we teach. Fortunately, Brady materials make that possible. When I first started in India, I was spending countless hours making slides, quizzes, tests, and handouts from scratch. Now, we use the Instructor Resources for Brady’s Paramedic Care: Principles and Practice. For some classes, I have a translator at my side. However, English is an official language in India and therefore a principle medium for medical education.

EMS in India is a relatively new but emerging field. Many states provide primary response emergency transport free of charge. In other places, private hospitals and companies are providing critical care transports for exorbitant rates that are unaffordable to the average citizen. At the mission hospital we are focusing solely on providing critical care transport at an affordable cost while the state government has contracted with a private company to provide free BLS level primary response.

The laws governing EMS in India are under development and we—as the only provider of critical care services in our region—have a unique opportunity to play a central role in setting a high standard for training and service in the swiftly developing field of EMS. Essentially, I have the chance to be a pioneer of life-saving techniques with the help of Brady’s comprehensive resources.

Greg Campbell volunteers at Lady Willingdon Hospital in Manali, India as a Consultant in Ambulance and Emergency Medical Technician Training: http://infovore.in/manalihos/ By U.S. standards, Campbell offers Level III Trauma Center services.  Prior to his involvement in India, patients had to wait as long as nine hours for a critical care level ambulance to arrive from Level I hospitals in the bordering state. Campbell’s responsibilities include working to develop an EMT-Paramedic program that will be accredited by an Indian agency and funded by foreign donors as well as student fees.

Unaffiliated Un-uniformity

February 24, 2012 Leave a comment
EMS

Photo credit: SantaCruzHealth.org

There are plenty of informative sites, blogs, and other variants of social media out there for the already-employed-EMT, but what about those of us that have gone to school, have a license, but have not been hired yet…for two years?

OK, the two years part may not be the norm, but the rest of it might be, to more folks than you may think. I went to a small community college in North Carolina, enrolled in a six-month course, took the state exam, failed the first time, then retested. This was all shortly before moving to New Hampshire.

Reciprocity

But did you know North Carolina does not require NREMT? I didn’t think it was a big deal. I heard of ‘reciprocity’ and thought that it might help. It seems that it does not extend very far. I looked into what was going to be needed for employment in NH, even though I knew I was not to be staying in NH for more than a year, but I desperately wanted to get my career started. I looked up websites, made phone calls, and knocked on office doors. Finally, I had to take a one-day ‘transition class’ for the state of NH. I was actually misinformed about this; the class had no bearing on my NH license.

Everyone tells me to get NREMT. Great, sure, have you read HOW to do this if you are “unaffiliated?” Excessively frustrating, not to mention, living paycheck to paycheck does not allow for it.

Now, I am facing the same thing in my new home state of Maine. There seems to be no ‘reciprocity’ between NC, NH, or ME. It has even been suggested that I may need to take the EMT-B course all over again!

Lack of uniformity

Now more to the point. Where is the uniformity? Hypothetically, if many states use the same detailed textbooks, specifically Brady Books, why is it so difficult for someone without NREMT to transfer to another state? Is what has been learned any different? Is the human body really any different from one state to the next?

I understand differences in protocol, which is why I took the $150 one day ‘transition class’ in NH. Should it really be this difficult (and costly) to transfer credentials from one state to another?

A possible solution

Here is an idea that has worked for me in EVERY other career field I have been in: hire me conditionally, with the stipulation that I get fully-licensed in said state within a specified number of months. This would solve MANY issues.

The issue of not being able to afford the process (as it would be a second income) and also would put me in direct daily contact with people who can steer me in the right direction. I have asked three different people about how to do this. Simply put, I have received three different answers.

So, have I done what is required educationally? Yes. Do I have a valid EMT-B license? Yes. Can I get employment? No.

There must be some sense of uniformity in the education process that could eliminate some of this hassle. How about a simple solution of offering to sit for NREMT along with state exams after completing a class in every state? Why not, if a majority of the schools use the SAME textbooks, right?  

Uniformity, in a career where we wear uniforms, where is it?

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Eric Carlson is a dad, husband, (unemployed) EMT, volunteer firefighter, writer, and fire protection systems specialist. Visit his blog: http://pheenyxsfyre.blogspot.com/