Re: Gathering of Eagles-Dallas

February 19, 2007

I tend to side with , not all EMS is blood and guts and in fact most is

not. We can and should learn from the battlefield as it's in ways a part of

our roots but we MUST learn from EMS itself.

Louis N. Molino, Sr., CET

FF/NREMT-B/FSI/EMSI

Freelance Consultant/Trainer/Author/Journalist/Fire Protection Consultant

Buddhist philosopher at-large

LNMolino@...

(Cell Phone)

(Home Phone)

(IFW/TFW/FSS Office)

(IFW/TFW/FSS Fax)

" A Texan with a Jersey Attitude "

" Great minds discuss ideas; Average minds discuss events; Small minds

discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 - 1962)

The comments contained in this E-mail are the opinions of the author and the

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I

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February 19, 2007

Ya know we can really stir up the prehospital arena by taking the lessons

working in Iraq and apply them here. Load, go and let the doctors fix it.

Not only has ems training become more broad, but so have patient health

conditions. We in Texas are just now catching up to the rest of the country with

the level of education for PHCP and we need to be thinking about where EMS

really is. BLS first on scene with 2 min of CPR if it is necessary then an

airway and continued CPR till ALS gets there, not so bad, and if you add in an

AED; the patient is suffering how?

There are so many things to re-visit and look at how we take care of them, the

fun to come is applying the techniques learned overseas to the street level

PHCP....

Chris

" Lemming, Steve " wrote:

The question certainly is valid as to what information would be

provided

by a nurse (a CEN, floor nurse, flight nurse?) Paramedic dispatchers

that have field experience would be helpful, but most are not allowed to

draw upon that information since it may vary according to the Medic or

call. Sticking to the script is the overriding rule for fear that

variance exposes a system to liability. Some systems, as hard as it may

be to believe do not provide ANY guidance or pre-arrival instructions

because of " liability. "

What has happened to the state's EMD program? I would think that this

would be encouraged to be required training for anyone who take EMS

calls if there is no proprietary system in place such as MPDS (Clawson.)

You don't hear much about it. I'm surprised that regional call centers

aren't at least setup for those who may be too small to purchase or pay

for the upkeep of the training requirements for MPDS.

My personal experience in the past was as a Paramedic in dispatch for a

private service with 911 contracts. This too was before the MPDS days. I

am married to a fire dispatcher/EMT who is a MPDS trainer.

Lt. Steve Lemming, AAS, LP

EMS Administration Officer

C-Shift

Azle, Texas Fire Department

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Re: Gathering of Eagles-Dallas

In a message dated 2/18/2007 9:31:07 P.M. Central Standard Time,

ExLngHrn@... <mailto:ExLngHrn%40aol.com> writes:

Why not experienced paramedics? It would provide a " field

practitioner's "

insight and might also be a nice position for someone who might

want to get

out of the field for a while....

And how does this differ from EMD? Other then the level of field

training by

the call taker?

when I went into dispatch at the tender age of 19 I had 3 years

of VERY

active EMT-B (OK, A back then but BLS is BLS) level field

experience, EMD at the

time was just starting to get discussed (I was in the Alarm room

the month

that Clawson's first articles on the Salt lake System appeared

and then later

his books and classes were starting up by the time I left. One

of the hardest

things to get past was the fact that as a call taker I was not

able to be an

EMT.

So if EMD is not a valid system as has been argued why wound

nurse or

Paramedic based triage be better?

Louis N. Molino, Sr., CET

FF/NREMT-B/FSI/EMSI

Freelance Consultant/Trainer/Author/Journalist/Fire Protection

Consultant

Buddhist philosopher at-large

LNMolino@... <mailto:LNMolino%40aol.com>

(Cell Phone)

(Home Phone)

(IFW/TFW/FSS Office)

(IFW/TFW/FSS Fax)

" A Texan with a Jersey Attitude "

" Great minds discuss ideas; Average minds discuss events; Small

minds

discuss people " Eleanor Roosevelt - US diplomat & reformer (1884

- 1962)

The comments contained in this E-mail are the opinions of the

author and the

author alone. I in no way ever intend to speak for any person or

organization that I am in any way whatsoever involved or

associated with unless I

specifically state that I am doing so. Further this E-mail is

intended only for its

stated recipient and may contain private and or confidential

materials

retransmission is strictly prohibited unless placed in the

public domain by the

original author.

February 19, 2007

>>There are so many things to re-visit and look at how we take care of them, the

fun to come is applying the techniques learned overseas to the street level

PHCP....<<

Apples and oranges. The vast majority of transports in the war zone are trauma,

and the hospitals and aid stations they are transported to aren't already filled

to overflowing with patients with dubious illnesses.

The majority of people in ERs shouldn't be in ERs. They should either be home,

or making an appointment with their PCP for treatment of their minor complaint.

The reasons for this are many and varied - poorly educated patients, under and

un-insured, laziness, economics - all play a role.

Plus, EMS handles a far wider variety of patients, not all of whom are well

served with minimal stabilization and rapid transport to a physician.

I will agree with you however, that the lessons learned in Iraq should induce a

sea-change in *trauma* care. In some systems, it already is.

--

Grayson, CCEMT-P, etc.

MEDIC Training Solutions

http://www.medictrainingsolutions.com/

February 19, 2007

I have to take issue with on Texas' place in providing education for

paramedics. In fact, we are far ahead of most other states in the education

and training that our paramedics get and the practices that they are allowed to

employ.

If you don't believe me, just take a look at any of the states from the

Mississippi River east. The very worst are the New England states (with a

couple

of local notable exceptions) and places like Pennsylvania, Ohio, New York, New

Jersey, Massachusetts, Connecticut, Rhode Island, Maine, and Vermont, and so

forth.

We're not where we ought to be, but we're a heck of a lot better off in MANY

of our programs than lots of other places.

As far as lessons learned in Iraq, it's not even close to what we work with

in Texas. In Iraq patients are rapidly transported to field hospitals with

state of the art trauma doctors and nurses and techs who spend every day of

their lives dealing with extreme trauma.

In Texas, you're lucky if you live close enough to a Level I or II trauma

center to get your patient to them in the same time that a soldier in Iraq gets

to the forward hospital. If you live in Abilene, or Commerce, or Austin, or

Brownsville or fifty other places in Texas, you're screwed because there's

nobody there who is capable of doing the kinds of stuff they do in those

hospitals

in Iraq. If you're in Houston or Dallas and you're lucky enough to get to

Ben Taub or Parkland soon enough, you may get similar treatment. Maybe you

have the best chance in Tyler of anywhere in the United States, because that

little town has a Level I and a Level II one block apart, and they each have 24

hour board certified trauma surgeon coverage.

But if you're not in one of those places, then your life is going to be in

the hands of the medics for a Looooong time. Better hope they're up to

it----and many, many of them are.

Gene

Gene G.

>

> Ya know we can really stir up the prehospital arena by taking the lessons

> working in Iraq and apply them here. Load, go and let the doctors fix it.

>

> Not only has ems training become more broad, but so have patient health

> conditions. We in Texas are just now catching up to the rest of the country

with

> the level of education for PHCP and we need to be thinking about where EMS

> really is. BLS first on scene with 2 min of CPR if it is necessary then an

> airway and continued CPR till ALS gets there, not so bad, and if you add in an

> AED; the patient is suffering how?

>

> There are so many things to re-visit and look at how we take care of them,

> the fun to come is applying the techniques learned overseas to the street

> level PHCP....

>

> Chris

> " Lemming, Steve " <slemming@...@c> wrote:

> The question certainly is valid as to what information would be provided

> by a nurse (a CEN, floor nurse, flight nurse?) Paramedic dispatchers

> that have field experience would be helpful, but most are not allowed to

> draw upon that information since it may vary according to the Medic or

> call. Sticking to the script is the overriding rule for fear that

> variance exposes a system to liability. Some systems, as hard as it may

> be to believe do not provide ANY guidance or pre-arrival instructions

> because of " liability. "

>

> What has happened to the state's EMD program? I would think that this

> would be encouraged to be required training for anyone who take EMS

> calls if there is no proprietary system in place such as MPDS (Clawson.)

> You don't hear much about it. I'm surprised that regional call centers

> aren't at least setup for those who may be too small to purchase or pay

> for the upkeep of the training requirements for MPDS.

>

> My personal experience in the past was as a Paramedic in dispatch for a

> private service with 911 contracts. This too was before the MPDS days. I

> am married to a fire dispatcher/EMT who is a MPDS trainer.

>

> Lt. Steve Lemming, AAS, LP

> EMS Administration Officer

> C-Shift

> Azle, Texas Fire Department

>

> This e-mail is confidential and intended solely for the use of the

> individual (s) to whom it is addressed. Any views or opinions presented

> are solely those of the author and do not necessarily represent those of

> The City of Azle or its policies. If you have received this e-mail

> message in error, please phone Steve Lemming (817)444-7108. Please also

> destroy and delete the message from your computer.

>

> For more information on The City of Azle, visit our web site at:

> <http://azle.http://azlhttp>

>

> Re: Gathering of Eagles-Dallas

>

> In a message dated 2/18/2007 9:31:07 P.M. Central Standard Time,

>

> ExLngHrn@... <mailto:ExLngHrn%mailto:Ex> writes:

>

> Why not experienced paramedics? It would provide a " field

> practitioner' pr

> insight and might also be a nice position for someone who might

> want to get

> out of the field for a while....

>

> And how does this differ from EMD? Other then the level of field

> training by

> the call taker?

>

> when I went into dispatch at the tender age of 19 I had 3 years

> of VERY

> active EMT-B (OK, A back then but BLS is BLS) level field

> experience, EMD at the

> time was just starting to get discussed (I was in the Alarm room

> the month

> that Clawson's first articles on the Salt lake System appeared

> and then later

> his books and classes were starting up by the time I left. One

> of the hardest

> things to get past was the fact that as a call taker I was not

> able to be an

> EMT.

>

> So if EMD is not a valid system as has been argued why wound

> nurse or

> Paramedic based triage be better?

>

> Louis N. Molino, Sr., CET

> FF/NREMT-B/FSI/ FF/

> Freelance Consultant/Trainer/ Freelance Consu Freelance Consul

> Consultant

> Buddhist philosopher at-large

> LNMolino@... <mailto:LNMolino%mailto:LN>

>

> (Cell Phone)

> (Home Phone)

> (IFW/TFW/FSS Office)

> (IFW/TFW/FSS Fax)

>

> " A Texan with a Jersey Attitude "

>

> " Great minds discuss ideas; Average minds discuss events; Small

> minds

> discuss people " Eleanor Roosevelt - US diplomat & reformer (1884

> - 1962)

>

> The comments contained in this E-mail are the opinions of the

> author and the

> author alone. I in no way ever intend to speak for any person or

>

> organization that I am in any way whatsoever involved or

> associated with unless I

> specifically state that I am doing so. Further this E-mail is

> intended only for its

> stated recipient and may contain private and or confidential

> materials

> retransmission is strictly prohibited unless placed in the

> public domain by the

> original author.

>

February 19, 2007

Just curious on who is still treating hypertension? This too was asked at the

conference and most of them do not have a protocol.

krin135@... wrote:

In a message dated 2/18/2007 6:22:32 PM Central Standard Time,

slemming@... writes:

Being febrile is a good start

Chuckle...actually, over a third of the geriatric patients that I see with

sepsis (uro or pneumo) have a normal or actually subnormal temp.

History of present illness, type of cough, type of sputum, neck vein

distention, lung sounds, heart sounds, liver size, type of edema, radiographic

results, lab results are all part of the work up.

You might notice that all but the last two are easily assessed by a well

educated paramedic in the field...

ck

S. Krin, DO FAAFP

February 20, 2007

In a message dated 2/20/2007 9:12:21 A.M. Central Standard Time,

fyremedic78133@... writes:

I don't know about other systems, but that is how my system interprets the

MPDS cards.

They need to re-read the book!

Louis N. Molino, Sr., CET

FF/NREMT-B/FSI/EMSI

Freelance Consultant/Trainer/Author/Journalist/Fire Protection Consultant

Buddhist philosopher at-large

LNMolino@...

(Cell Phone)

(Home Phone)

(IFW/TFW/FSS Office)

(IFW/TFW/FSS Fax)

" A Texan with a Jersey Attitude "

" Great minds discuss ideas; Average minds discuss events; Small minds

discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 - 1962)

The comments contained in this E-mail are the opinions of the author and the

author alone. I in no way ever intend to speak for any person or

organization that I am in any way whatsoever involved or associated with unless

I

specifically state that I am doing so. Further this E-mail is intended only for

its

stated recipient and may contain private and or confidential materials

retransmission is strictly prohibited unless placed in the public domain by the

original author.

************************************** Check out free AOL at

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February 20, 2007

In a message dated 2/20/2007 9:27:38 A.M. Central Standard Time,

ExLngHrn@... writes:

Ahh, but isn't the claim behind MPDS that there will be no variances?

And we hear the same argument from the CISM types, yet we see practices that

are in fact VERY different from the " published " procedures.

Louis N. Molino, Sr., CET

FF/NREMT-B/FSI/EMSI

Freelance Consultant/Trainer/Author/Journalist/Fire Protection Consultant

Buddhist philosopher at-large

LNMolino@...

(Cell Phone)

(Home Phone)

(IFW/TFW/FSS Office)

(IFW/TFW/FSS Fax)

" A Texan with a Jersey Attitude "

" Great minds discuss ideas; Average minds discuss events; Small minds

discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 - 1962)

The comments contained in this E-mail are the opinions of the author and the

author alone. I in no way ever intend to speak for any person or

organization that I am in any way whatsoever involved or associated with unless

I

specifically state that I am doing so. Further this E-mail is intended only for

its

stated recipient and may contain private and or confidential materials

retransmission is strictly prohibited unless placed in the public domain by the

original author.

************************************** Check out free AOL at

http://free.aol.com/thenewaol/index.adp. Most comprehensive set of free

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web, free AOL Mail and much more.

February 20, 2007

In a message dated 2/20/2007 9:42:34 A.M. Central Standard Time,

jkaymdc@... writes:

The intentions are pure, the methodology and educational standards we have

been using are faulty!

Ah but Jules the road to hell is paved with what?

Intentions are just that, actions are where the rubber meets the road

everyday, good, bad, and ugly as it may be.

Louis N. Molino, Sr., CET

FF/NREMT-B/FSI/EMSI

Freelance Consultant/Trainer/Author/Journalist/Fire Protection Consultant

Buddhist philosopher at-large

LNMolino@...

(Cell Phone)

(Home Phone)

(IFW/TFW/FSS Office)

(IFW/TFW/FSS Fax)

" A Texan with a Jersey Attitude "

" Great minds discuss ideas; Average minds discuss events; Small minds

discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 - 1962)

The comments contained in this E-mail are the opinions of the author and the

author alone. I in no way ever intend to speak for any person or

organization that I am in any way whatsoever involved or associated with unless

I

specifically state that I am doing so. Further this E-mail is intended only for

its

stated recipient and may contain private and or confidential materials

retransmission is strictly prohibited unless placed in the public domain by the

original author.

************************************** Check out free AOL at

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web, free AOL Mail and much more.

February 20, 2007

In a message dated 2/20/2007 10:00:25 A.M. Central Standard Time,

ExLngHrn@... writes:

1) " Can we have a study guide? "

2) " Is this going to be on the test? "

I heard that too in my I class last year!

Louis N. Molino, Sr., CET

FF/NREMT-B/FSI/EMSI

Freelance Consultant/Trainer/Author/Journalist/Fire Protection Consultant

Buddhist philosopher at-large

LNMolino@...

(Cell Phone)

(Home Phone)

(IFW/TFW/FSS Office)

(IFW/TFW/FSS Fax)

" A Texan with a Jersey Attitude "

" Great minds discuss ideas; Average minds discuss events; Small minds

discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 - 1962)

The comments contained in this E-mail are the opinions of the author and the

author alone. I in no way ever intend to speak for any person or

organization that I am in any way whatsoever involved or associated with unless

I

specifically state that I am doing so. Further this E-mail is intended only for

its

stated recipient and may contain private and or confidential materials

retransmission is strictly prohibited unless placed in the public domain by the

original author.

************************************** Check out free AOL at

http://free.aol.com/thenewaol/index.adp. Most comprehensive set of free

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web, free AOL Mail and much more.

February 20, 2007

Or being dispatched with lights and sirens to leg pain or ankle pain just

because the patient has cardiac history? I don't know about other systems,

but that is how my system interprets the MPDS cards.

Barry E. McClung, FF/EMT-P

_____

From: texasems-l [mailto:texasems-l ] On

Behalf Of wegandy1938@...

Sent: Sunday, 18 February, 2007 22:53

To: SLemming@...; Wegandy1938@...

Cc: texasems-l

Subject: Re: Gathering of Eagles-Dallas

How many times have we all been dispatched to a " patient with abdominal

pain " and found a full code on arrival?

February 20, 2007

Ahh, but isn't the claim behind MPDS that there will be no variances? Alas, we

all know that there are too many variances from locale to locale. Remember,

according to the MPDS proponents, trained chimps can do the job, because it's

all about blindly following the cards.

Too much of what we do in EMS is being done for statistical validity and not

enough is being done because it's good for the patients.

-Wes Ogilvie, MPA, JD, EMT

Austin, Texas

Re: Gathering of Eagles-Dallas

How many times have we all been dispatched to a " patient with abdominal

pain " and found a full code on arrival?

February 20, 2007

-Wes Ogilvie, MPA, JD, EMT says:

>>> Too much of what we do in EMS is being done for statistical

validity and not enough is being done because it's good for the

>>patients.

Very true. But to play the devils advocate, it isn't only " cookbook "

driven methods like MPDS that have caused the " simplification " of EMS.

We quit requiring " thinking " , critical or otherwise, in our

curriculums. Spoon fed medicine is became the path of least resistance

and satisfied the " I just want to help out my community, so teach me

what I need to know to pass my test and drive the ambulance. "

Adult education can be difficult to teach at any given time. Most of

the recruitment and retention of EMS in especially the rural areas I'm

familiar was through the " guilt " method. Not the best motivation,

however, the truth of it is they believe they are doing and learning

what it good for the patient. They just want it to be the " I stayed at

a Holiday Inn " method.

The intentions are pure, the methodology and educational standards we

have been using are faulty!

Jules

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February 20, 2007

Being the current victim (I mean student) of a paramedic class, I couldn't agree

more. We have all too many students who don't have an adequate foundation of

knowledge (algebra, chemistry, and biology) along with the two most common

questions:

1) " Can we have a study guide? "

2) " Is this going to be on the test? "

All too many of us fail to recognize that while a paramedic class may or may not

be for college credit, it is a college level course. Failing to recognize such

is a virtual recipe for failure.

-Wes " Can I have a study guide? " Ogilvie