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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.

> >

> >

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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.

> > > >

> > > >

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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

>

>

>

>

>

>

>

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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

>

>

>

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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

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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.

> > >

> > >

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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

>

>

>

>

>

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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

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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

>

>

>

>

>

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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

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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

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.

> > >

> > >

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Guest guest

Very nice Gene. I always enjoy reading your responses, entertaining yet very

true and most of the time just.

LMc

Danny wrote:

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

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.

> > >

> > >

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We're talking apricots and cherries here. I have tested nurses and

physicians in ACLS and PALS too.

But, as I keep repeating, my original post had to do with testing paramedics

on an RSI protocol, and I said the testing needed to simulate field

conditions.

I can tell you that I have had nurses and physicians attend some of our

scenario drills and they went away shaking their heads and muttering " I don't

see

how they do that. I never had any idea what they do. "

I would be quite happy to run a scenario in the hospital setting. First,

I'd have the lights go out just as the code started. Then I would have about

30 screaming, drunk, people surround the patient and responders. Next, I

would set off the sprinkler system and put some FD fans in the doors to create

gale force winds. Then I would have the only place where they could get out of

this environment 50 yards away and three flights up. Oh, by the way, I'd

coat the stairs with motor oil, the next best thing to mud. And the manikin

would be chock full of lead so that it weighed 325 pounds. Then, one of the bags

of equipment would have been left behind and it would contain all the drugs.

Get the picture?

Hey doc! Hey nurse? Want to play?

Gene G.

> 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

>

>

>

>

>

>

>

>

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ACLS, PALS, etc., those are generalized certifications that apply to

a broad spectrum of healthcare providers. However, protocols are a

different story. While the algorithm is the same, the condition in

which it is carried out is not the same.

In the ER you have the luxury of having a doctor present,

respiratory techs, nurses, and the various specialization teams.

There are a lot of people there to catch mistakes, to help each

other where someone else might be weak, and added helping hands.

On the ambulance, you have the medic and their partner. Maybe you

get lucky and have a few volunteers on with you or a pumper crew.

However, we are expected to be able to handle the emergency at the

paramedic level with out these resources.

We have all been rookies at one point, and we have all seen rookies

who were really good. More often though, we see a lot of rookies who

struggle or new hires that are set in their ways from other

services. It is important to identify these negative characteristics

and weaknesses that might often get over looked by a nurse who is

the examiner.

I could go and on, and we could go into skills that aren't performed

by nurses in the hospital such as intubation, surgical airways,

needle decompression, etc. I just feel that it would better if we

left it to our own profession to test our own professionals, and to

further educate them. We don't allow nurses who aren't medics to

teach EMS classes, why should we allow them to test us? We certainly

don't test new hire nurses at the paramedic level.

Nate

>

> 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

>

>

>

>

>

>

>

>

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Don't forget the smell of bowel movements and that smell of the

apartment that hasn't been cleaned in 15 years.

>

> We're talking apricots and cherries here. I have tested nurses

and

> physicians in ACLS and PALS too.

>

> But, as I keep repeating, my original post had to do with testing

paramedics

> on an RSI protocol, and I said the testing needed to simulate

field

> conditions.

>

> I can tell you that I have had nurses and physicians attend some

of our

> scenario drills and they went away shaking their heads and

muttering " I don't see

> how they do that. I never had any idea what they do. "

>

> I would be quite happy to run a scenario in the hospital

setting. First,

> I'd have the lights go out just as the code started. Then I

would have about

> 30 screaming, drunk, people surround the patient and responders.

Next, I

> would set off the sprinkler system and put some FD fans in the

doors to create

> gale force winds. Then I would have the only place where they

could get out of

> this environment 50 yards away and three flights up. Oh, by the

way, I'd

> coat the stairs with motor oil, the next best thing to mud. And

the manikin

> would be chock full of lead so that it weighed 325 pounds. Then,

one of the bags

> of equipment would have been left behind and it would contain all

the drugs.

> Get the picture?

>

> Hey doc! Hey nurse? Want to play?

>

> Gene G.

>

>

>

> > 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

> >

> >

> >

> >

> >

> >

> >

> >

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Gene,

Ok, I'll bite.

First, I agree with much of what you say, but if I gave you point by point

on my agreements with you I think it would go to your head, and then we

might have trouble extricating you. =)

The main point that struck me is the exaggerated and really demeaning way

that you referenced nurses and others (eg reference that RNs could only

teach paramedics about bed baths). That sort of literary device is great

for a beer where you know your audience but not much for esprit de corps on

the world wide web of EMS interested folks. That is the attitude I was

referring to that I believe may hinder EMS efforts to move forward.

I think that some our divergent opinions on protocol testing is because I

think that I understand your training perhaps better than you understand

mine (I do not really mean YOURS, but that of EMS.) I think that you may

underestimate the level of education and experience of a typical EM boarded

physician. Perhaps I am overestimating as I can only attest to my personal

experience. It is possible that you may not have a good dialogue with

enough of them to know. I know that many MDs to not have much dialogue with

EMS, often attitude is an issue. You would be amazed what you can learn if

you shadowed an ER MD and listen and ask lots of questions.

Let me also respond that I think that I would be qualified to do " protocol

testing " for a paramedic. No, I was never a paramedic. In fact, because I

would be qualified to do some testing doesn't mean I would be qualified to

do all of it or that I am qualified to be a paramedic. I am not an EMS

director and personally as of this moment would not be the best person to do

the testing for a whole system. I have not done an EMS fellowship. Could

I test RSI and field skills? You betcha... However, there is a lot about

incident command, safety, driving emergency vehicles, extrication, etc...

that I would not be qualified to perform.

I assume that my experience as an EM physician is close to average. Perhaps

you are not aware that many of us, as part of our training, have hands on

experience.

Assuming ER MDs had my training, then they would have:

-trained with 911 operators and observed calls and verbal lay person

protocols

-ridden the box and worked MANY shifts with paramedics, usually 12 or more

hours at a time

-been able to give MCO orders in the field since they were present

-intubated in the field on a bouncing ambulance using a whistler nasally

-given multpile lectures to EMS students

-reviewed protocols with EMS directors for potential issues and improvements

-reviewed EMS charts for QA

-perhaps done EMS research

-performed paramedic testing to insure adequate fund of knowledge

-ridden in EMS helicopters for transport

-given countless complicated medical direction to incoming fixed wing and

helicopter crews, sometimes for patients transported for hours

-and of course be used to waking up on call and working many codes and

resusciatiions of complex medical ICU patients with very little time to

assimilate the data, and a lot of folks running around (not so unlike being

at a nightclub as a paramedic!)

So, I appreciate that your job is difficult and that you must perform it

under circumstances that are different than a hospital. However, I think

that the paramedic model is operating under the license of an MD who

ultimately is reponsible, or should be, for their performance. As such, I

believe it is up to them to dictate testing. I suspect many directors

involve senior level paramedics to do much of this testing. I don't really

see how you compare an EMS MD doing paramedic testing to you as a paramedic

evaluating an ER MDs work in the hospital. Not even close my friend,

cheers....

Kirk D. Mahon, MD, ABEM

6106 Keller Springs Rd

Dallas, TX 75248

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Damm Gene,

That sounds like the last CPR I ran. LOL......The hospital folks couldnt handle

it.

Tom

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

>

>

>

>

>

>

>

>

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In a message dated 02-Jun-06 07:44:05 Central Daylight Time,

medicnate2004@... writes:

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

Considering that there are cases where Dentists have learned to rebuild

teeth and jaws on animals....who do you think did the teaching?

S. Krin, DO FAAFP

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In a message dated 02-Jun-06 19:15:28 Central Daylight Time,

wegandy1938@... writes:

I would be quite happy to run a scenario in the hospital setting. First,

I'd have the lights go out just as the code started. Then I would have

about

30 screaming, drunk, people surround the patient and responders. Next, I

would set off the sprinkler system and put some FD fans in the doors to

create

gale force winds. Then I would have the only place where they could get

out of

this environment 50 yards away and three flights up. Oh, by the way, I'd

coat the stairs with motor oil, the next best thing to mud. And the

manikin

would be chock full of lead so that it weighed 325 pounds. Then, one of the

bags

of equipment would have been left behind and it would contain all the drugs.

Get the picture?

Chuckle... will tell you that one sounds like one of the scenarios that

I'd dream up for my *basic* classes...screaming nursing students. flashing

lights from a couple of squad cars and a Bumbulance, and my two younger sons

running through the crowd with large squirt guns 'shooting' up in the air to

simulate rain...and makes a good obnoxious drunk...just like I make a

good belligerent cop...

My favorite one years ago when I still had the Izuzu Trooper was to park it

on a side slope and make the students extricate *me* as part of their

practical...250 pounds of 'dead' weight with the seat all the way forward and

the

driver's door on the up hill side....

and they were judged on teamwork and 'coping' skills as well for that

drill...

ck

S. Krin, DO FAAFP

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In a message dated 02-Jun-06 20:05:33 Central Daylight Time,

kirkmahon@... writes:

So, I appreciate that your job is difficult and that you must perform it

under circumstances that are different than a hospital. However, I think

that the paramedic model is operating under the license of an MD who

ultimately is reponsible, or should be, for their performance. As such, I

believe it is up to them to dictate testing. I suspect many directors

involve senior level paramedics to do much of this testing. I don't really

see how you compare an EMS MD doing paramedic testing to you as a paramedic

evaluating an ER MDs work in the hospital. Not even close my friend,

Kirk:

I've known Gene for some years now, both in correspondence and in person. I

suspect that part of the problem is that he's seen too many docs and nurses

on scene with no clue...both down in the blood and the mud and in the court

room after...

While my training was not as formal as yours was, I've been in Gene's

position before in terms of working with docs (and sometimes nurses) in the ED

and

the field where they needed instructions...sometimes on the heel...to

function well. I've seen other cases, especially involving student nurses,

techs and

sometimes student doctors, where the students were 'first in' on the scene

and did an admirable job of understanding the basics...'air way, ventilation,

stop the bleeding, secure broken bones' simply because they understood the

first role of being a student in a strange place... " Know Thy Limitations " ...

While his blanket condemnation *was* a bit harsh, and probably intended to

engender the level of conversation he got, the attitude 'to test field

situations, you have to have graders who known what the field is like,

otherwise the

graders are just going down a checklist' is one that most folks who do EMS

testing subscribe to, as they should.

Not everyone in EM has the kind of varied background that is so often

represented here...I know that you have made comments before that tell me that

you

would be comfortable in the field...as am I, as well as , Jeff Meyers

and several others.

On the other hand, I've worked with a fair number of BCEM (ABEM/ABOEM) docs

who can't be bothered trying to understand some of the differences between

the back of a rig and the back of the ED...funny thing is that it seems like

the bigger facility they trained in, the less they were interested in field

work...I know guys like Rick Frykberg over on the trauma list used to be a Navy

doc and went through the Combat Casualty Care Course at Camp Bullis, TX...as

do most military docs at some stage of their career...I've seen folks come

out of that one swearing that they weren't going to go to the field ever again

(it's two weeks of tent living and grubbing in the South Texas landscape for

those who don't know about it...with docs, nurses, dentists and a few Musical

Sircus Corps folks tied in and about a Company of Marines to provide much of

the field training...and boy, don't the Leathernecks enjoy getting over on

the officers, especially the Army and AF types.) Be that as it may, many docs

working the ED or otherwise interfacing with EMS do not know what needs to

happen...

and it's partially our fault as EMS physicians (not 'just* EM physicians)

for not teaching our colleagues better.

ck

S. Krin, DO FAAFP

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In a message dated 03-Jun-06 10:55:29 Central Daylight Time,

THEDUDMAN@... writes:

I agree, EMS does have some challenges...and the calls that Gene

describes certainly can be difficult and trying on the patience...but

even more important are the calls that are not physical and emotional

challenges...because we rarely teach new recruits, rookies,

paramedic-wanna-bes or whatever name we call them...that EMS has those

situations but the majority of what we do is listening, holding hands,

and giving rides to the hospital. Until we can teach both sides of

the coin...we will continue to have folks with poor job satisfaction

and short-term experience before they look elsewhere to progress their

medical career.

One of the first classes given to the EMS students I have been responsible

for over the years (and has helped with some of them) has stated the

importance of learning from the 'routine runs'...the nursing home to doctor's

offices, home to dialysis center, etc...and that the " High Speed, Low Drag "

runs will be few and far between, and mostly involve misery on both ends of the

stretcher for little gain on the part of the person *on* the stretcher...

Part of the problem is that too many of our candidates think that EMS is

like " Emergency " , " Rescue 911 " , or " Life in the Streets " ...and miss the

reality

of the 300 pound 'non emergency' transfers for needed care, since that's not

shown on TV.

ck

S. Krin, DO FAAFP

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In a message dated 03-Jun-06 10:59:51 Central Daylight Time,

THEDUDMAN@... writes:

Only one small difference....EMS, RN, and MD/DO's and even DDS's ALL

treat humans...vets don't. Comparing an RN testing/training an EMS

person to an animal vet teaching a human dentist might speak about how

you feel about your patients...but it is no true comparison...

Dudley, I was teasing...however, I will point out that most vets could

probably do a better job of treating a human than most MD/DOs could do treating

a

horse!

ck

S. Krin, DO FAAFP

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Sounds like something we'd run too except in a desert enviroment

where the bugs and the heat kill you.

>

> Damm Gene,

> That sounds like the last CPR I ran. LOL......The hospital folks

couldnt handle it.

>

> Tom

>

>

>

>

> 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

> >

> >

> >

> >

> >

> >

> >

> >

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Doc,

I also believe, by reading all these posts, that EMS has a generally

over-inflated sense of both our importance and our abilities. By

reading these posts I am lead to believe that every call we run is

" crash-burn-die, life-saving, death-cheatin', knife and gun club " type

activity. I must have led a sheltered life as a Paramedic...because I

would only classify about 8 to 12 percent of the patients I have

treated as these.

The remainder were in various stages of health, various socio-economic

status, in and around common areas we all live, work and deal with.

The biggest majority needed someone who would listen to them, PAY

ATTENTION to them, and take their complaints seriously...even though

they didn't weigh 350 lbs, down 3 flights of muddy stairs, in the dark,

surrounded by drunk, load billegerent people. They possibly needed

some small interventions to help them feel better, make them more

comfortable and then they needed a compassionate ride to the ER where

hopefully we could hand them off to an MD and an RN that would listen

and pay attention to them so that they could return better off to their

families and loved ones who were worried sick because this was the

first time they had had any exposure to the healthcare system outside

of possibly their primary care physician if they were fortunate enough

to have one.

I agree, EMS does have some challenges...and the calls that Gene

describes certainly can be difficult and trying on the patience...but

even more important are the calls that are not physical and emotional

challenges...because we rarely teach new recruits, rookies,

paramedic-wanna-bes or whatever name we call them...that EMS has those

situations but the majority of what we do is listening, holding hands,

and giving rides to the hospital. Until we can teach both sides of

the coin...we will continue to have folks with poor job satisfaction

and short-term experience before they look elsewhere to progress their

medical career.

So, Doc, I'd be happy to shadow you for a few shifts...matter of fact,

if you were around SA, I would like to get all my medics to do the

same...because you may not be upside down in a ditch with 2 feet of

water around you in the rain at night...but I bet I could learn

somethng none the less....that I could apply to the one or two calls we

run that aren't like these EMS scenarios we have been reading.

Dudley

Re: Re: Protocol Testing

Gene,

Ok, I'll bite.

First, I agree with much of what you say, but if I gave you point by

point

on my agreements with you I think it would go to your head, and then we

might have trouble extricating you. =)

The main point that struck me is the exaggerated and really demeaning

way

that you referenced nurses and others (eg reference that RNs could only

teach paramedics about bed baths). That sort of literary device is

great

for a beer where you know your audience but not much for esprit de

corps on

the world wide web of EMS interested folks. That is the attitude I was

referring to that I believe may hinder EMS efforts to move forward.

I think that some our divergent opinions on protocol testing is because

I

think that I understand your training perhaps better than you

understand

mine (I do not really mean YOURS, but that of EMS.) I think that you

may

underestimate the level of education and experience of a typical EM

boarded

physician. Perhaps I am overestimating as I can only attest to my

personal

experience. It is possible that you may not have a good dialogue with

enough of them to know. I know that many MDs to not have much dialogue

with

EMS, often attitude is an issue. You would be amazed what you can

learn if

you shadowed an ER MD and listen and ask lots of questions.

Let me also respond that I think that I would be qualified to do

" protocol

testing " for a paramedic. No, I was never a paramedic. In fact,

because I

would be qualified to do some testing doesn't mean I would be qualified

to

do all of it or that I am qualified to be a paramedic. I am not an EMS

director and personally as of this moment would not be the best person

to do

the testing for a whole system. I have not done an EMS fellowship.

Could

I test RSI and field skills? You betcha... However, there is a lot

about

incident command, safety, driving emergency vehicles, extrication,

etc...

that I would not be qualified to perform.

I assume that my experience as an EM physician is close to average.

Perhaps

you are not aware that many of us, as part of our training, have hands

on

experience.

Assuming ER MDs had my training, then they would have:

-trained with 911 operators and observed calls and verbal lay person

protocols

-ridden the box and worked MANY shifts with paramedics, usually 12 or

more

hours at a time

-been able to give MCO orders in the field since they were present

-intubated in the field on a bouncing ambulance using a whistler nasally

-given multpile lectures to EMS students

-reviewed protocols with EMS directors for potential issues and

improvements

-reviewed EMS charts for QA

-perhaps done EMS research

-performed paramedic testing to insure adequate fund of knowledge

-ridden in EMS helicopters for transport

-given countless complicated medical direction to incoming fixed wing

and

helicopter crews, sometimes for patients transported for hours

-and of course be used to waking up on call and working many codes and

resusciatiions of complex medical ICU patients with very little time to

assimilate the data, and a lot of folks running around (not so unlike

being

at a nightclub as a paramedic!)

So, I appreciate that your job is difficult and that you must perform

it

under circumstances that are different than a hospital. However, I

think

that the paramedic model is operating under the license of an MD who

ultimately is reponsible, or should be, for their performance. As

such, I

believe it is up to them to dictate testing. I suspect many directors

involve senior level paramedics to do much of this testing. I don't

really

see how you compare an EMS MD doing paramedic testing to you as a

paramedic

evaluating an ER MDs work in the hospital. Not even close my friend,

cheers....

Kirk D. Mahon, MD, ABEM

6106 Keller Springs Rd

Dallas, TX 75248

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Only one small difference....EMS, RN, and MD/DO's and even DDS's ALL

treat humans...vets don't. Comparing an RN testing/training an EMS

person to an animal vet teaching a human dentist might speak about how

you feel about your patients...but it is no true comparison...

Dudley

PS: Paramedics teach and test nurses all the time in all types of

courses (ACLS, PALS, CPR, BTLS, etc). Don't believe I have seen TNA or

BNE advocate only RN's can teach and train RN's....but then again we

can't learn anything from them anyway...

Re: Re: Protocol Testing

In a message dated 02-Jun-06 07:44:05 Central Daylight Time,

medicnate2004@... writes:

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

Considering that there are cases where Dentists have learned to

rebuild

teeth and jaws on animals....who do you think did the teaching?

S. Krin, DO FAAFP

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