Protocol Testing

May 31, 2006

Gene,

Thank you for respecting my tender sensibilities.

Is this post for real? Only senior level paramedics can evaluate the skills of

a paramedic? Isn't that a little like a fox guarding the hen-house? So, from

this day forward, only the 5 physicians identified by Dr. Mahan and " senior "

paramedics can ever look upon EMS folks and evaluate the skills with which we

operate? Really....who exactly were the first field experienced personnel that

started this little gig we call EMS? What??? A physician or physicians started

the process??? How could that be??? What do they possibly know about working

EMS in the field?

For EMS Week, we had an excellent guest speaker who has been in this business

for over 25 years come speak to our organization about what it takes to be

successful in this career field...and he said it best...until we learn that our

business is RARELY about the crash burn die call...and that the people that we

SERVE (hmmmm serve....maybe that should be in the name of our profession???

Nah...no place for it) expect us to hold a hand, listen to a story, transport

them safely and comfortably to the facility of their choice, and, if need be,

provide competent care we are going to continually set people up for failure and

drive them out of this profession...and that we are a part of a system...an

ever-growing part of that system.

The next piece is that we are a PART of the HEALTH CARE SYSTEM....it starts with

the patient or a bystander recognizing a medical problem and ends when the

patient is discharged back to their normal life. In Caroline, AAOS, and

many other textbooks, I don't see it listed as the world, the EMS Health care

system, the HOSPITAL Health Care System, REHAB Health Care System and back to

the world....we are in this together and until we get over our suspicions and

paranoia about the " motives " of other members of the healthcare field, we will

never progress beyond the blue-collar worker that brings sick people to the

hospital....what we do in the field is no different than what is done in doctors

offices or hospitals. You can train a monkey for crying out loud to do the

skills we do....look at me....it ain't rocket surgery for crying out loud.

Do ED physicians refuse to work with anesthesiologists because the ED is not the

OR? Does the Internal Medicine doc not want the ED doc to help work the code in

the ICU because it isn't an emergency room? Does the physician with the

chestpain patient in his office not want EMS there to take over care and

transport the patient because we are not family practice paramedics???? In the

SLAM class only the physician instructors can evaluate the skills of the

physicains who attend, the RN's, etc or is this only a one-way street...they

can't look at us but we sure can evaluate them...

We have to stop this primitive way of thinking and become part of the healthcare

system. If we are evaluating our skills to remove a door with a Hurst tool than

no, I don't think a physician or nurse has a role in telling me how to do

that...but if I want evaluation on how my medics are initiating IV access or

preparing and administering IV medications then I would welcome an RN's input.

If I have questions about the use of a CPAP, how to percuse a chest or new

methods in administering nebulized medications an RT would be a great

resource....and if I want input on how we are intubating, conducting physical

assessments or performing 12-lead EKG procedures than a physician would be the

one I might turn to....we have an agency here that is trying to get funding to

open a regional Fire/EMS/Police training facility. I was recently asked my

thoughts as the EMS Guy...and I explained that I thought it was a good

idea...but we really don't need training facility to practice the skills we use

everyday (i.e. Removing patients down a flight of stairs in a stair chair or

backboard...we do it 12 to 16 times a day....) what my medics need is excellent

training and mentoring by those in healthcare who operate at a higher level...a

chance to shadow an ED physician to work on patient assessment skills, a chance

to shadow an RT to better evaluate and treat respiratory issues...and (this one

we are doing) attending patients with our new cardiologist in town to perform

and read 12-lead EKG's in her office on her patients so that we are better

prepared and practiced to do it when we are on our own...unfortunately I don't

have a Board Certified Cardiologist Paramedic on staff so I guess this lowly

opportunity to perform and be judged by a physician will have to do...I sure

hope the residents I protect will forgive me for this oversight.

We are working on a project with 4 other EMS agencies and a 5 hospital system in

San . This is a cardiac alert type project where we call the MI in the

field, the cath lab get mobilized and we deliver the patient to the ED and/or

cath lab. We have been in this for 30 days and so far we have had several good

cases where door to cath was dramatically reduced....just got back from a

meeting tonight where ED physicians, cardiologists, pathologists, RN's,

administrators, Paramedics and EMT's all were in attendance and all spoke about

experiences, how to make the project work better, and reviewed the data...FROM

ALL FACETS of the project....and ALL in attendance offered input and suggestions

for all 7 goals of the project encompassing EMS care, ED care and Cath Lab care.

I only wish I had known before going to this that all the non-EMS input I would

receive was garbage and everything that works for us in EMS was garbage to the

in-hospital folks....I guess we wouldn't have wasted each other's time.

Intubation, 12-lead EKG, patient assessment, IV's, bandaging....its done the

same no matter where it happens...the only difference is where it

happens.....BTW, do you have an order for that Phenergan or did your senior

field paramedic not give you one?

Dudley

Re: Re: Protocol Testing

The author, respecting the tender sensibilities of many readers of this list,

has generously deleted the expletives. Please feel free to add your own

appropriately profane adjectives as needed to fit the meaning as you read.

A nurse? A $@#^(^! NURSE? Give me a BREAK! What business does a nurse or

a medical control doctor have coming onto an ambulance and evaluating anyone?

And WHAT THE #@$% does anybody from medical control know about field work

except how to read the protocol anyway? Sheesh. This makes me gag.

I haven't given a bed bath in the truck in my whole career. So what's the

nurse going to evaluate anyway.

How about let's go into the hospital and evaluate the proficiency of the

nurses and doctors there. Just how far do you think you'd get with that? But

it

makes as much sense (actually it makes more sense) to have us go into the

hospital and evaluate the skills of those who practice there as it does for

nurses

and anybody other than a physician who spends lots of time in the field with

medics (which narrows it down to approximately 5 in Texas) doing evaluations

on paramedics.

You have inadvertently identified what's wrong with EMS today. The wrong

people control it.

Senior, experienced PARAMEDICS are the ones that ought to be doing these

evaluations and MAYBE your own medical director. The only nurses that should

ever

be involved are those who are also paramedics and who have extensive field

experience AS A PARAMEDIC. The only docs who ought to have a word to say about

how somebody performs in the field are those who have once been paramedics and

YOUR medical control doc, and that's only for those whose docs are active in

the field.

Anybody got some phenergan? I'm nauseated. Nurse indeed~

Gene G.

In a message dated 5/30/06 15:03:46 Central Daylight Time,

jthornton@... writes:

> Subj: Re: Protocol Testing

> Date:5/30/06 15:03:46 Central Daylight Time

> From:jthornton@...

> Reply-to:texasems-l

> To:texasems-l

> Sent from the Internet

>

> Our dept. uses written & practical evaluations. We do this once a

> year. We also have someone from Medical Control (maybe nurse or

> Dr.) that will ride out periodically to evaluate us. I think a good

> bit of evaluation can be done by reviewing reports.

>

> As for having different levels of Medics, I don't think it is a bad

> idea. For example, I work for a fire dept. and we have approx. 80

> paramedics. The drivers and officers are given the option of

> dropping their paramedic. They do not get rid of their cert through

> TDH, but they are EMTs under medical direction. For our Batallion

> Chiefs, it is mandatory. If a service uses RSI, I think it is

> reasonable to not make the drivers and officers responsible for that

> skill. One advantage that we have is that there are no EMTs except

> for a few (5 or so) that are drivers and officers.

>

> >

> > Wayne,

> >

> > I agree with Gene, competency based evaluation is the only way to

> go.

> >

> > My question to your agency is why create 2 different leveles? Why

> not expect

> > all your paramedics to be able to perform at an expected level?

> This sounds

> > like you are moving back to the EMT/Paramedic team approach, which

> while it

> > does have limited advantages, dual medics is much more desired. It

> seems

> > like it would confuse staffing problems, with differenct levels of

> > paramedics instead of just 1 standard.

> >

> > Protocol Testing

> >

> > Here is a question for those of you that require testing of

> personnel on

> > service protocols. My company wants to establish this type of

> testing, as

> > they want to develop a level 1 & 2 for each level. Ex: Level 2

> paramedics

> > would be allowed to do more advanced procedures, such as RSI,

> while the

> > level 1 paramedics would not be able to do this unless tested and

> cleared by

> > the MD.

> >

> > Where do most of you come up with your testing questions? Is

> there a good

> > test bank that can be bought, or does each service develop their

> own

> > questions and skills testing for protocols?

> >

> > Your input would be appreciated.

> >

> > Wayne

> >

> > ---------------------------------

> > Blab-away for as little as 1Â¢/min. Make PC-to-Phone Calls using

> Yahoo!

> > Messenger with Voice.

> >

June 1, 2006

YAWZA, YAWZA! Right on, .

Gene

> And Gene this is why I have only one Field Training Supervisor who

> evaluates my crews. The FTS has more experience then I care to list

> here. And guess what, he even evaluates me (the director) not that

> I screw up much anymore after 21 years of doing this. The FTS also

> helps do yearly evaluations of the employees. My medical director

> is proactive but the FTS and I are the ones who say yay or nay.

>

> Gene you are da man. About damn time we stand up for us, the EMS

> people, and not bow down to those who think they know best.

>

> stephen stephens

> Just a hick from the sticks

>

> > > >

> > > > Wayne,

> > > >

> > > > I agree with Gene, competency based evaluation is the only way

> to

> > > go.

> > > >

> > > > My question to your agency is why create 2 different leveles?

> Why

> > > not expect

> > > > all your paramedics to be able to perform at an expected

> level?

> > > This sounds

> > > > like you are moving back to the EMT/Paramedic team approach,

> which

> > > while it

> > > > does have limited advantages, dual medics is much more

> desired. It

> > > seems

> > > > like it would confuse staffing problems, with differenct

> levels of

> > > > paramedics instead of just 1 standard.

> > > >

> > > > Protocol Testing

> > > >

> > > > Here is a question for those of you that require testing of

> > > personnel on

> > > > service protocols. My company wants to establish this type of

> > > testing, as

> > > > they want to develop a level 1 & 2 for each level. Ex: Level

> 2

> > > paramedics

> > > > would be allowed to do more advanced procedures, such as RSI,

> > > while the

> > > > level 1 paramedics would not be able to do this unless tested

> and

> > > cleared by

> > > > the MD.

> > > >

> > > > Where do most of you come up with your testing questions?

> Is

> > > there a good

> > > > test bank that can be bought, or does each service develop

> their

> > > own

> > > > questions and skills testing for protocols?

> > > >

> > > > Your input would be appreciated.

> > > >

> > > > Wayne

> > > >

> > > > ---------------------------------

> > > > Blab-away for as little as 1¢/min. Make PC-to-Phone Calls

> using

> > > Yahoo!

> > > > Messenger with Voice.

> > > >

June 1, 2006

Kirk,

Of course I use exaggeration for emphasis. I don't know how many medical

directors in Texas actually get out and mix it up on the streets with the

troops. I know Ed Racht does, Dave Persse used to. At one time Pepe did, and

I

know there are others.

Whether or not a physician is qualified to assess a street medic's competency

entirely depends upon the physician's field experience with prehospital

medicine.

There are some of them that are only paper shufflers. There are others,

like Bledsoe, who had a career as a Paramedic before medical school. So each

service must decide what's appropriate.

What I mean to say is that just because one has MD, DO, or RN after his or

her name, it's no indication whatsoever that s/he is qualified to judge a

paramedic's competency in the field situation.

To me it makes more sense for me to evaluate the ER staff than for them to

evaluate a street medic's street abilities.

I hasten to add that my post was one of a series in which we were talking

about how to evaluate a paramedic's RSI competencies. I said it should be done

in a realistic scenario situation.

I know of NO nurses who are not either Paramedics or CRNAs who would know the

first thing about RSI. Just because somebody works for a medical control

group tells me nothing either. Do the medical control group's folks ever ride

out with the troops? If not, they are incompetent to evaluate a street medic

on a skill that is to be performed in the prehospital setting.

And no, my current medical director would not be qualified to evaluate a

medic's actions in the prehospital setting because he has little or no

prehospital

experience. He's learning, to his credit, but his ideas often are way, way

off the mark.

Now, I ask you. Are YOU qualified to evaluate Paramedics? Have you been

one? If not, how do you know what the field considerations are?

As for the message I want to send, it is a clear one. EMS ought to be run

by folks who know about EMS. The physicians and nurses have a place in

teaching, but most of the time they are ignorant of the conditions and

priorities

that must be dealt with in the field.

So let them teach us how to do medicine, but also let them understand through

experience that the way we apply their teaching is far different in the field

than it is in the controlled environment of the hospital of physician's

office.

BTW, we welcome you to come see how it's done any time if you're not

street-smart. Be prepared to manage a 300+ pound patient in fulminating

pulmonary

edema with just you and a female partner, 18 miles out in the country. Be

prepared to manage when you can't get a line because of your patient's fat and

the fact that she keeps bradying down and going in and out of PEA. Be

prepared to take a chewing out from the ER doc who can't understand why you

paced

instead of giving atropine the minute she bradied down. Be prepared to get the

tube on the first try, even though she has no neck and an overbite. Deliver

her breathing and in sinus rhythm to an ER that's staffed by a doctor with a

rude and nasty attitude and one nurse. Do not expect any thanks for getting

her there alive, but expect your medical director to be called with a complaint

because you didn't get a line sooner and paced her (successfully) and

maintained cardiac output till you could finally get a line.

Be prepared to take 5 days for your back to recover from getting this lady

out of the mobile home with nobody to help but your partner, but don't complain

about your back ache for fear of being fired. Remember that the stretcher,

monitor, and oxygen weigh approximately 100 pounds, so add that to your 300+

lady. Think you can do it over and over again?

Sound unreasonable to you? It happened to one of my friends within the last

week. And it happens every day to medics.

See why I have a little attitude?

And I didn't need the phenergan after all. That was just a literary device

to add a little humor.

Let's all keep our sense of humor. Otherwise we'll need more than

phenergan.

Best,

Gene

> Gene,

>

> You will need a prescription for Phenergan (yes, from a doctor.)

>

> It is no wonder why EMS has so much trouble going forward. Why don't you

> re-read your email and evaluate whether that is the message that you want to

> broadcast over the internet?

>

> To summarize, there are only 5 doctors in Texas who are qualified to

> evaluate a medic? And, in general, your medical director would not be

> qualified?

>

> It would be funny if it wasn't such a prevalent attitude....

>

> Kirk D. Mahon, MD, ABEM

>

> 6106 Keller Springs Rd

> Dallas, TX 75248

>

June 1, 2006

Thorazine makes me shuffle, stick my tongue out, and drool. How about

Zofran?

g

>

> Anybody got some phenergan? I'm nauseated. Nurse indeed~

>

> how about some Thorazine instead?

>

> ck

>

June 1, 2006

In a message dated 6/1/2006 7:57:08 P.M. Central Daylight Time,

wegandy1938@... writes:

Thorazine makes me shuffle, stick my tongue out, and drool. How about

Zofran?

g

and that's different from how you act after a couple of Margaritas how?

ck

June 1, 2006

Dudley,

First, you've confused what I said and what Dr. Mahon said. Go back and

reread.

Next, you say some good things. And some not so good things. I won't

attack, but will just make a couple of points.

The thread that led to the posts you're referring to began with a question

about RSI testing. That's how it got started and it was in response to that

post that I made the statements I did. In my first post, I included the

service's medical director in a suggested panel of three evaluators, with an EMS

educator and another senior paramedic. Later, I added the corollary that not

all physicians, even some EMS medical directors, lack sufficient knowledge,

experience, and insight about EMS to be able to accurately assess a paramedic's

field competencies in some areas.

I reject the idea that paramedics cannot judge and evaluate other paramedics.

Physicians evaluate other physicians, nurses evaluate other nurses, pilots

evaluate other pilots, and cowboys evaluate other cowboys.

What I was trying to get across in less than a novel, is that nobody ought to

evaluate the competency of one unless s/he has done the job s/he's

evaluating.

Of course, a cardiologist could evaluate a paramedic's cardiology skills, but

the same cardiologist might not be competent to evaluate the paramedic's

ability to run a code IN THE FIELD. Does that make sense?

I am all for establishing much more interaction with other medical

professionals.

I was talking about one specific situation, the evaluation of a paramedics

competency to perform RSI in the field.

Later, somebody mentioned nurses from a medical control group being frequent

field evaluators, and I rejected that as being inappropriate. I still reject

that. There are nurse/paramedics that are certainly competent to judge

paramedics. But unless a nurse has functioned as a paramedic, s/he is not

qualified to judge field performance.

While, as you say, bleeding control is bleeding control, surely you will

admit that there are vast differences in how that intervention is delivered in

the

field and in the ER.

All I am saying is that apples should be judged by a specialist in apples and

oranges by a specialist in oranges. Most physicians and nurses are not

familiar with prehospital practices. The internist is the one I want teaching

my

medics how to assess the medical patient, but s/he may not be competent to

assess my paramedic's assessment skills in a field scenario setting.

I believe that field competencies should be evaluated in a realistic field

setting. That does not mean that competencies cannot be evaluated in the

abstract. In fact, that should precede the field evaluations.

But we have all seen the book-smart medic who couldn't find the airway kit on

the ambulance if his life depended on it, or who can tell you every step in

starting an IV but never hits one in the field.

Yes, by all means, let's build bridges. But remember that a bridge has two

ends. On the whole, the medical profession has ignored EMS when it hasn't

been outright hostile toward EMS. So there's work to be done on both sides.

Gene G.

> Gene,

>

> Thank you for respecting my tender sensibilities.

>

> Is this post for real? Only senior level paramedics can evaluate the skills

> of a paramedic? Isn't that a little like a fox guarding the hen-house? So,

> from this day forward, only the 5 physicians identified by Dr. Mahan and

> " senior " paramedics can ever look upon EMS folks and evaluate the skills with

> which we operate? Really....who exactly were the first field experienced

> personnel that started this little gig we call EMS? What??? A physician or

> physicians started the process??? How could that be??? What do they possibly

know

> about working EMS in the field?

>

> For EMS Week, we had an excellent guest speaker who has been in this

> business for over 25 years come speak to our organization about what it takes

to be

> successful in this career field...and he said it best...until we learn that

> our business is RARELY about the crash burn die call...and that the people

> that we SERVE (hmmmm serve....maybe that should be in the name of our

> profession??? Nah...no place for it) expect us to hold a hand, listen to a

story,

> transport them safely and comfortably to the facility of their choice, and, if

> need be, provide competent care we are going to continually set people up for

> failure and drive them out of this profession...and that we are a part of a

> system...an ever-growing part of that system.

>

> The next piece is that we are a PART of the HEALTH CARE SYSTEM....it starts

> with the patient or a bystander recognizing a medical problem and ends when

> the patient is discharged back to their normal life. In Caroline, AAOS,

> and many other textbooks, I don't see it listed as the world, the EMS Health

> care system, the HOSPITAL Health Care System, REHAB Health Care System and

> back to the world....we are in this together and until we get over our

> suspicions and paranoia about the " motives " of other members of the healthcare

> field, we will never progress beyond the blue-collar worker that brings sick

> people to the hospital....what we do in the field is no different than what is

> done in doctors offices or hospitals. You can train a monkey for crying out

> loud to do the skills we do....look at me....it ain't rocket surgery for

crying

> out loud.

>

> Do ED physicians refuse to work with anesthesiologists because the ED is not

> the OR? Does the Internal Medicine doc not want the ED doc to help work the

> code in the ICU because it isn't an emergency room? Does the physician with

> the chestpain patient in his office not want EMS there to take over care and

> transport the patient because we are not family practice paramedics???? In

> the SLAM class only the physician instructors can evaluate the skills of the

> physicains who attend, the RN's, etc or is this only a one-way street...they

> can't look at us but we sure can evaluate them...

>

> We have to stop this primitive way of thinking and become part of the

> healthcare system. If we are evaluating our skills to remove a door with a

Hurst

> tool than no, I don't think a physician or nurse has a role in telling me how

> to do that...but if I want evaluation on how my medics are initiating IV

> access or preparing and administering IV medications then I would welcome an

RN's

> input. If I have questions about the use of a CPAP, how to percuse a chest

> or new methods in administering nebulized medications an RT would be a great

> resource....and if I want input on how we are intubating, conducting physical

> assessments or performing 12-lead EKG procedures than a physician would be

> the one I might turn to....we have an agency here that is trying to get

> funding to open a regional Fire/EMS/Police training facility. I was recently

asked

> my thoughts as the EMS Guy...and I explained that I thought it was a good

> idea...but we really don't need training facility to practice the skills we

use

> everyday (i.e. Removing patients down a flight of stairs in a stair chair or

> backboard...we do it 12 to 16 times a day....) what my medics need is

> excellent training and mentoring by those in healthcare who operate at a

higher

> level...a chance to shadow an ED physician to work on patient assessment

skills,

> a chance to shadow an RT to better evaluate and treat respiratory

> issues...and (this one we are doing) attending patients with our new

cardiologist in

> town to perform and read 12-lead EKG's in her office on her patients so that

we

> are better prepared and practiced to do it when we are on our

> own...unfortunately I don't have a Board Certified Cardiologist Paramedic on

staff so I

> guess this lowly opportunity to perform and be judged by a physician will have

> to do...I sure hope the residents I protect will forgive me for this

> oversight.

>

> We are working on a project with 4 other EMS agencies and a 5 hospital

> system in San . This is a cardiac alert type project where we call the

MI

> in the field, the cath lab get mobilized and we deliver the patient to the ED

> and/or cath lab. We have been in this for 30 days and so far we have had

> several good cases where door to cath was dramatically reduced....just got

back

> from a meeting tonight where ED physicians, cardiologists, pathologists,

> RN's, administrators, Paramedics and EMT's all were in attendance and all

spoke

> about experiences, how to make the project work better, and reviewed the

> data...FROM ALL FACETS of the project....and ALL in attendance offered input

and

> suggestions for all 7 goals of the project encompassing EMS care, ED care and

> Cath Lab care. I only wish I had known before going to this that all the

> non-EMS input I would receive was garbage and everything that works for us in

> EMS was garbage to the in-hospital folks....I guess we wouldn't have wasted

> each other's time.

>

> Intubation, 12-lead EKG, patient assessment, IV's, bandaging....its done the

> same no matter where it happens...the only difference is where it

> happens.....BTW, do you have an order for that Phenergan or did your senior

field

> paramedic not give you one?

>

> Dudley

>

> Re: Re: Protocol Testing

>

> The author, respecting the tender sensibilities of many readers of this

> list,

> has generously deleted the expletives. Please feel free to add your own

> appropriately profane adjectives as needed to fit the meaning as you read.

>

> A nurse? A $@#^(^! NURSE? Give me a BREAK! What business does a nurse

> or

> a medical control doctor have coming onto an ambulance and evaluating

> anyone?

> And WHAT THE #@$% does anybody from medical control know about field work

> except how to read the protocol anyway? Sheesh. This makes me gag.

>

> I haven't given a bed bath in the truck in my whole career. So what's the

> nurse going to evaluate anyway.

>

> How about let's go into the hospital and evaluate the proficiency of the

> nurses and doctors there. Just how far do you think you'd get with that?

> But

> it

> makes as much sense (actually it makes more sense) to have us go into the

> hospital and evaluate the skills of those who practice there as it does for

> nurses

> and anybody other than a physician who spends lots of time in the field with

> medics (which narrows it down to approximately 5 in Texas) doing evaluations

> on paramedics.

>

> You have inadvertently identified what's wrong with EMS today. The wrong

> people control it.

>

> Senior, experienced PARAMEDICS are the ones that ought to be doing these

> evaluations and MAYBE your own medical director. The only nurses that should

> ever

> be involved are those who are also paramedics and who have extensive field

> experience AS A PARAMEDIC. The only docs who ought to have a word to say

> about

> how somebody performs in the field are those who have once been paramedics

> and

> YOUR medical control doc, and that's only for those whose docs are active in

> the field.

>

> Anybody got some phenergan? I'm nauseated. Nurse indeed~

>

> Gene G.

>

> In a message dated 5/30/06 15:03:46 Central Daylight Time,

> jthornton@... writes:

>

> > Subj: Re: Protocol Testing

> > Date:5/30/06 15:03:46 Central Daylight Time

> > From:jthornton@...

> > Reply-to:texasems-l

> > To:texasems-l

> > Sent from the Internet

> >

> > Our dept. uses written & practical evaluations. We do this once a

> > year. We also have someone from Medical Control (maybe nurse or

> > Dr.) that will ride out periodically to evaluate us. I think a good

> > bit of evaluation can be done by reviewing reports.

> >

> > As for having different levels of Medics, I don't think it is a bad

> > idea. For example, I work for a fire dept. and we have approx. 80

> > paramedics. The drivers and officers are given the option of

> > dropping their paramedic. They do not get rid of their cert through

> > TDH, but they are EMTs under medical direction. For our Batallion

> > Chiefs, it is mandatory. If a service uses RSI, I think it is

> > reasonable to not make the drivers and officers responsible for that

> > skill. One advantage that we have is that there are no EMTs except

> > for a few (5 or so) that are drivers and officers.

> >

> > >

> > > Wayne,

> > >

> > > I agree with Gene, competency based evaluation is the only way to

> > go.

> > >

> > > My question to your agency is why create 2 different leveles? Why

> > not expect

> > > all your paramedics to be able to perform at an expected level?

> > This sounds

> > > like you are moving back to the EMT/Paramedic team approach, which

> > while it

> > > does have limited advantages, dual medics is much more desired. It

> > seems

> > > like it would confuse staffing problems, with differenct levels of

> > > paramedics instead of just 1 standard.

> > >

> > > Protocol Testing

> > >

> > > Here is a question for those of you that require testing of

> > personnel on

> > > service protocols. My company wants to establish this type of

> > testing, as

> > > they want to develop a level 1 & 2 for each level. Ex: Level 2

> > paramedics

> > > would be allowed to do more advanced procedures, such as RSI,

> > while the

> > > level 1 paramedics would not be able to do this unless tested and

> > cleared by

> > > the MD.

> > >

> > > Where do most of you come up with your testing questions? Is

> > there a good

> > > test bank that can be bought, or does each service develop their

> > own

> > > questions and skills testing for protocols?

> > >

> > > Your input would be appreciated.

> > >

> > > Wayne

> > >

> > > ---------------------------------

> > > Blab-away for as little as 1¢/min. Make PC-to-Phone Calls using

> > Yahoo!

> > > Messenger with Voice.

> > >

June 1, 2006

Very different. After two Margaritas I tend to dance, sing, and recite lewd

limericks.

GG

>

> In a message dated 6/1/2006 7:57:08 P.M. Central Daylight Time,

> wegandy1938@... writes:

>

> Thorazine makes me shuffle, stick my tongue out, and drool. How about

> Zofran?

>

> g

>

> and that's different from how you act after a couple of Margaritas how?

>

> ck

>

June 2, 2006

I have yet to see a reason why nurses should test paramedics? You

don't see paramedics testing nurses? Kind of seems like a step in the

wrong direction to start having the hospital staff train/test people

who work prehospital.

IMHO, thats like asking a vet to test dental students.

Nate

June 2, 2006

MARGARITA!!!!!!!

She bery bery good to me !!!!!!

wegandy1938@... wrote:

Very different. After two Margaritas I tend to dance, sing, and recite lewd

limericks.

GG

>

> In a message dated 6/1/2006 7:57:08 P.M. Central Daylight Time,

> wegandy1938@... writes:

>

> Thorazine makes me shuffle, stick my tongue out, and drool. How about

> Zofran?

>

> g

>

> and that's different from how you act after a couple of Margaritas how?

>

> ck

>

June 2, 2006

That's not entirely true...I have tested many a nurse in ACLS, PALS,

etc. Shoot, I've even gotten to test cardiologists. The name of the

game is still healthcare " system. "

Last year I interviewed one of our state medical directors about his

system because they were doing prehospital TPA. One of the things I

asked was how did you get through the politics of it all and his reply

was basically, politics is about decision making. Politics is also

about communication.

Ground units treat heart attacks. So do ERs...so do cath labs. We all

supposedly have the same goal of minimizing damage. This being the

case, he basically said we all need to chit chat about the fact we have

the same goal and how we can help each other do our job better, i.e. ER

docs can learn from cardiologists, nurses can learn from medics, dogs

CAN like cats, etc. etc. His system appears to be working as one

incident I covered had a call to cath time of like 50 some minutes.

That's 9-1-1 call.

We need to remember we can all be on the same side of trying to get life

saving treatment to our patients. Just because they're nurses doesn't

make them bad. I mean come on, you could even love a Redskins fan if

you tried.

Re: Protocol Testing

I have yet to see a reason why nurses should test paramedics? You

don't see paramedics testing nurses? Kind of seems like a step in the

wrong direction to start having the hospital staff train/test people

who work prehospital.

IMHO, thats like asking a vet to test dental students.

Nate

June 2, 2006

Nice explanation. What is so different in EMS that this should not happen?

wegandy1938@... wrote:

Dudley,

First, you've confused what I said and what Dr. Mahon said. Go back and

reread.

Next, you say some good things. And some not so good things. I won't

attack, but will just make a couple of points.

The thread that led to the posts you're referring to began with a question

about RSI testing. That's how it got started and it was in response to that

post that I made the statements I did. In my first post, I included the

service's medical director in a suggested panel of three evaluators, with an EMS

educator and another senior paramedic. Later, I added the corollary that not

all physicians, even some EMS medical directors, lack sufficient knowledge,

experience, and insight about EMS to be able to accurately assess a paramedic's

field competencies in some areas.

I reject the idea that paramedics cannot judge and evaluate other paramedics.

Physicians evaluate other physicians, nurses evaluate other nurses, pilots

evaluate other pilots, and cowboys evaluate other cowboys.

What I was trying to get across in less than a novel, is that nobody ought to

evaluate the competency of one unless s/he has done the job s/he's

evaluating.

Of course, a cardiologist could evaluate a paramedic's cardiology skills, but

the same cardiologist might not be competent to evaluate the paramedic's

ability to run a code IN THE FIELD. Does that make sense?

I am all for establishing much more interaction with other medical

professionals.

I was talking about one specific situation, the evaluation of a paramedics

competency to perform RSI in the field.

Later, somebody mentioned nurses from a medical control group being frequent

field evaluators, and I rejected that as being inappropriate. I still reject

that. There are nurse/paramedics that are certainly competent to judge

paramedics. But unless a nurse has functioned as a paramedic, s/he is not

qualified to judge field performance.

While, as you say, bleeding control is bleeding control, surely you will

admit that there are vast differences in how that intervention is delivered in

the

field and in the ER.

All I am saying is that apples should be judged by a specialist in apples and

oranges by a specialist in oranges. Most physicians and nurses are not

familiar with prehospital practices. The internist is the one I want teaching my