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EMS / Paramedicine
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James L
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Mar 24, 2007, 08:47 PM
 
Hey all,

I have noticed in a few recent threads we have quite a few firefighters, EMT's, med students, etc on these boards.

I was curious about the system(s) you work in. It hit me that while I know several EMS providers from the US, we have never really talked "system" before.

In Canada (where I live) the entrance level of training in most systems is called Primary Care Paramedic, and involves about 450-500 hours of training after taking approximately 80 - 120 hours of first aid courses. Primary Care Paramedics are IV endorsed (in my province anyway), with a symptoms relief package consisting of IV NS, IV Dextrose and Thiamine for hypoglycemia (with SC Glucagon when IV acccess is a no go), Nitro and ASA for cardiac chest pain, nebulized Ventolin for SOB (when appropriate), SC Epi and PO Benadryl for anaphylaxis, SC or IV Narcan for opiate OD, Entonox for pain relief, and AED use. This is our "BLS" level of care.

Our system also uses Advanced Care Paramedics, which are your standard ALS medic... about 1 year of school full time (alternating between classroom, clinical, and precepting time). Advanced airway management, 12 lead ECG's, chest decompression, etc.

This system of EMS is supplemented with fire based first responders, with approximately 40-80 hours of training.

A part timer in the government run service (3rd party... not fire or private) I work for makes an hourly rate of approximately $20 per hour when they start (which includes an in lieu of benefits). A full timer, usually working a 4 on 4 off shift rotation, will start somewhere between $60,000 and $70,000 per year, with full benefits.

I would be interested in hearing about other systems.

Cheers!

James L
( Last edited by James L; Mar 25, 2007 at 02:05 AM. )
     
alligator
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Mar 24, 2007, 09:09 PM
 
I'm not in medicine yet, but oddly enough, I was looking into "mini-medical school" tonight. Here's the link: Mini Medical School - Academic Health Center, University of Minnesota

I'm currently only on the Emergency Response Team at my place of employment. 8 hours of training.
     
James L  (op)
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Mar 24, 2007, 10:18 PM
 
Originally Posted by alligator View Post
I'm not in medicine yet, but oddly enough, I was looking into "mini-medical school" tonight. Here's the link: Mini Medical School - Academic Health Center, University of Minnesota

I'm currently only on the Emergency Response Team at my place of employment. 8 hours of training.
Completely politically incorrect, but when I read "mini medical school" I flashed on a doctor who only treats midgets.
     
bstone
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Mar 25, 2007, 12:20 AM
 
I am trained as an EMT-Intermediate in the US. I have been working on ambulances for just about 5 years now. I did 140 hours of EMT-Based and another 140 hours of EMT-Intermediate. The protocols I was trained at are:

Airway: Intubation and med admin via ETT, CombiTube, OPA/NPA & BVM
Cardiac: 3 lead EKG interpretation, manual defibrillation, 1:10,000 IV Epi and Atropine IV for asystole and pulseless electrical activity
Anaphylaxis: 1:1000 Epi SC/IM
OD: Narcan IM/IV
Resp: Albuterol via Neb
Alcohol Detox: Thiamine (vitamin B1)
Diabetes: D5W IV and glucagon
Nerve agent: Mark II Autoinjector, Amyl Nitrite IM

and good old fashioned oxygen

That is considered Intermediate level care. Paramedic level care has many more skills like check decompression, rapid sequence intubation, 12 lead EKG, crichs. I get to watch those from time to time.
     
voodoo
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Mar 25, 2007, 12:38 AM
 
And here I was thinking paramedicine was something akin to parapsychology..



V
I could take Sean Connery in a fight... I could definitely take him.
     
SSharon
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Mar 25, 2007, 01:06 AM
 
I think the real question is who has seen the movie "Mother Juggs and Speed?"
I was trained as an EMT-B in Israel so aside from all the typical first responder training I had some extensive mass casualty drills. Side note: providing emergency care with a bullet proof jacket on is not easy.
While in Israel I also spent a lot of time on their ALS rigs, some of which have paramedics and some of which have paramedics and doctors. Most ambulance crews have more than 2 people btw and the chain of command is a bit different.
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James L  (op)
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Mar 25, 2007, 02:05 AM
 
Originally Posted by bstone View Post
I am trained as an EMT-Intermediate in the US. I have been working on ambulances for just about 5 years now. I did 140 hours of EMT-Based and another 140 hours of EMT-Intermediate. The protocols I was trained at are:

Airway: Intubation and med admin via ETT, CombiTube, OPA/NPA & BVM
Cardiac: 3 lead EKG interpretation, manual defibrillation, 1:10,000 IV Epi and Atropine IV for asystole and pulseless electrical activity
Anaphylaxis: 1:1000 Epi SC/IM
OD: Narcan IM/IV
Resp: Albuterol via Neb
Alcohol Detox: Thiamine (vitamin B1)
Diabetes: D5W IV and glucagon
Nerve agent: Mark II Autoinjector, Amyl Nitrite IM

and good old fashioned oxygen

That is considered Intermediate level care. Paramedic level care has many more skills like check decompression, rapid sequence intubation, 12 lead EKG, crichs. I get to watch those from time to time.
Thanks for sharing bstone!

If I could ask, which of the skills above are EMT-I, versus EMT-B? It would seem your skill set (at the EMT-I level) is very comparable to our Primary Care Paramedic level of training. Our PCP's don't intubate or perform basic ACLS, but seem to do several hundred hours more of education. I wonder if the additional education is A&P and patho?

What is the system like that you practice in?
     
James L  (op)
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Mar 25, 2007, 02:07 AM
 
Originally Posted by voodoo View Post
And here I was thinking paramedicine was something akin to parapsychology..



V
More so than you know on some shifts!

     
James L  (op)
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Mar 25, 2007, 02:12 AM
 
Originally Posted by SSharon View Post
I think the real question is who has seen the movie "Mother Juggs and Speed?"
I was trained as an EMT-B in Israel so aside from all the typical first responder training I had some extensive mass casualty drills. Side note: providing emergency care with a bullet proof jacket on is not easy.
It's actually interesting you say that. We have some people wearing bullet proof jackets at work now in our company, but some systems have issued them to all of their paramedics now. Here is an article on Calgary EMS:

http://www.gov.calgary.ab.ca/EMS/news/news_001.htm

Cheers,

James L

p.s. MJ&S is almost as much a right of passage as watching old Emergency reruns!
     
bstone
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Mar 25, 2007, 02:43 AM
 
Originally Posted by James L View Post
Thanks for sharing bstone!

If I could ask, which of the skills above are EMT-I, versus EMT-B? It would seem your skill set (at the EMT-I level) is very comparable to our Primary Care Paramedic level of training. Our PCP's don't intubate or perform basic ACLS, but seem to do several hundred hours more of education. I wonder if the additional education is A&P and patho?

What is the system like that you practice in?
I would agree that your PCPs learn much more A&P and patho and we do. We had one 4 hour lecture of "anatomy & physiology". It was a joke and a half. When it came to exams about intubation we were tested very in depth about the A&P of the system. We also had to know the exact mechanism of action for our meds- most of which we promptly forgot after the test. Little of that knowledge sticks as what we are doing is training to save lives in a prehospital setting.

Locally, Basics are quite basic. They don't intubate, start IVs, push any meds but they do use OPA/NPAs, BVMs and supplementary O2. Full range of spinal immobilzation, extrication, etc.
     
bstone
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Mar 25, 2007, 02:45 AM
 
Originally Posted by SSharon View Post
I think the real question is who has seen the movie "Mother Juggs and Speed?"
I was trained as an EMT-B in Israel so aside from all the typical first responder training I had some extensive mass casualty drills. Side note: providing emergency care with a bullet proof jacket on is not easy.
While in Israel I also spent a lot of time on their ALS rigs, some of which have paramedics and some of which have paramedics and doctors. Most ambulance crews have more than 2 people btw and the chain of command is a bit different.
Shaya, one evening we were bringing a PT into St Mary's ER and a CFD bus pulled up. The medics were wearing bullet proof vests. I asked one of them why and she said "we work in and around the projects". That was answer enough. There is a horror story of a MedEx bus getting shot up a few years ago when it came too close to the projects.
     
James L  (op)
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Mar 25, 2007, 02:54 AM
 
bstone, is your system 3rd party ems? Fire based? private? I am interested in deployment models along with the training information we have discussed.
     
bstone
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Mar 25, 2007, 03:01 AM
 
Originally Posted by James L View Post
bstone, is your system 3rd party ems? Fire based? private? I am interested in deployment models along with the training information we have discussed.
The two systems I have done work with are private EMS providers. One is service that has no 911 contracts but has contracts with nursing homes, half way homes and hospitals to do inter-facility transport and emergency response. The other private service provides the 911 emergency medical response for a county.
     
IceEnclosure
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Mar 25, 2007, 03:07 AM
 
A friend and former roommate of mine is a salvage diver and when on a job is also the EMT. I don't know all the details and such, but he's trained like a road-going EMT with the whole underwater thing thrown in. There's a lot of hyperbaric chamber stuff involved as well. It was all kind of crazy sounding.
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bstone
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Mar 25, 2007, 12:05 PM
 
I am also a PADI Certified Open Water Diver. I would really like to get the "Rescue Diver" card but I have a lot of training to do just to get to that. It would be cool tho.
     
SSharon
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Mar 25, 2007, 12:12 PM
 
Those vests are all cheating. We carried 4 shrapnel vests and 4 bullet proof vests. You could move around with the shrapnel vest on, but the others had a nice lead plate that made it sort of difficult.

bstone, do you do 911 response with Fallon or did you do 911 response back home that I didn't know about?
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bstone
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Mar 25, 2007, 12:18 PM
 
Originally Posted by SSharon View Post
Those vests are all cheating. We carried 4 shrapnel vests and 4 bullet proof vests. You could move around with the shrapnel vest on, but the others had a nice lead plate that made it sort of difficult.

bstone, do you do 911 response with Fallon or did you do 911 response back home that I didn't know about?
When I was in Intermediate school last year (in New Hampshire) I was doing time wit Rockingham Regional Ambulance. Private service that does the 911 response for their county. It was a good, good experience. I don't work for anyone local, but that might change.
     
iranfromthezoo
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Mar 25, 2007, 12:40 PM
 
I'm an EMT-B here in Mississippi about about to be a FFII with Hazmat and Rescue Operations.... The firehouse does run paramedic engines and basic trucks but we do not transport or anything like that. Our dept along with the rest of the 3 counties around us contract out to AMR (which I recommend never to work for or use, at least not here).

So I don't know how things are done elsewhere but we avg 7 calls a day with 6.5 being medical.

We just show up before or with ambo (depends where the ambo is stationed at the time) and we work with them and do everything to help the guys out....
     
bstone
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Mar 25, 2007, 12:42 PM
 
Originally Posted by iranfromthezoo View Post
I'm an EMT-B here in Mississippi about about to be a FFII with Hazmat and Rescue Operations.... The firehouse does run paramedic engines and basic trucks but we do not transport or anything like that. Our dept along with the rest of the 3 counties around us contract out to AMR (which I recommend never to work for or use, at least not here).

So I don't know how things are done elsewhere but we avg 7 calls a day with 6.5 being medical.

We just show up before or with ambo (depends where the ambo is stationed at the time) and we work with them and do everything to help the guys out....
I had a 90 day EMT-B card in MS back in 2005. I was there for a few months helping out in Waveland over in Hancock County. Where are you located?
( Last edited by bstone; Mar 25, 2007 at 12:59 PM. )
     
James L  (op)
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Mar 25, 2007, 12:49 PM
 
Originally Posted by iranfromthezoo View Post
we avg 7 calls a day with 6.5 being medical.
Is that in a 12 hour shift?

That would be fairly average for our units stationed in the suburbs (7 calls in a 12 hour shift). It is not uncommon for our cars right in the city to do 10-12 calls in a 12 hour shift.
     
SSharon
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Mar 25, 2007, 12:57 PM
 
Working in tel-aviv, jerusalem, and haifa I averaged 4-5 calls on night shifts (11pm-7am) and 9-10 calls during the morning shift (7am-3pm). In chicago the most I ever had with the private I was working for was 12 calls (6am-6pm), but there we had to drive much further distances.
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bstone
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Mar 25, 2007, 12:59 PM
 
On my BLS service we average anywhere between 2-6 calls for an overnight shift (1800-0700). Depends on a full moon or not.
     
James L  (op)
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Mar 25, 2007, 02:59 PM
 
Originally Posted by SSharon View Post
Working in tel-aviv, jerusalem, and haifa I averaged 4-5 calls on night shifts (11pm-7am) and 9-10 calls during the morning shift (7am-3pm). In chicago the most I ever had with the private I was working for was 12 calls (6am-6pm), but there we had to drive much further distances.
On my BLS service we average anywhere between 2-6 calls for an overnight shift (1800-0700). Depends on a full moon or not.
Sounds pretty similar.
     
   
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