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  1. #176
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    Quote Originally Posted by FireMedic049 View Post
    Not sure why that would be necessary, but........

    Endotracheal tube, King-LT, Combi-tube and a needle cricothyrotomy (or however that's spelled) are the options that I have/had at my disposal. I believe some places can do surgical cricothyrotomies. Beyond that, there's a tracheotostomy, but that's typically an in hospital procedure.

    To add to this, just because medics have the training and authority to use advanced airways doesn't mean they're going to automatically go to those. (Though, sadly, there are some that do I'm sure).

    Myself, I always consider basic measures first. Sometimes BLS stuff is all you need for a particular emergency, and as fun as intubating is when it's necessary, I'd much prefer to be able to just pop an OPA in a patient that only needs that much to keep their airway open., or an NPA is the situation fits. However, some patients require more than this, and that is one example where a medic does in fact make decisions as I have to decide with a particular patient whether an OPA or NPA is efficient enough or not. If in my opinion it is not, I choose to go with a more advanced airway. And in extreme cases where a patient is conscious enough not to tolerate an airway but they currently need or imminently will need advanced airway securing, I have to make the choice whether I chemically put them down to enable securing of said advanced airway. Just examples of decision making that goes on, all with the point that any smart medic will look at BLS first but have to make the decision as to whether that is enough or not. Has nothing to do with "being above" using BLS airways, it's whether or not that is enough for the patient or if we need to use more advanced airways we're trained and allowed to utilize.

    I'm all for being able to use an OPA or NPA and nothing else. Less stress and potential trauma to the patient, less stress on me, easier for everyone. But I won't skimp and cheat and just use that for the sake of making my job easier at the expense of my patient's well being just like I won't automatically jump to ALS care simply because I can and it's more "fun".

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    I suppose a Police Officer is also doing the same job when he starts CPR.

    Let's take the reasoning further. A boy scout is also doing "the same job" when he treats a bloody nose. Lifeguards, security guards... the list goes on and on.

    They all assess and treat... they don't transport, but neither do Paramedics in many parts of the country.
    Last edited by ChiefKN; 07-25-2011 at 07:46 PM.
    I am now a past chief and the views, opinions, and comments are mine and mine alone. I do not speak for any department or in any official capacity. Although, they would be smart to listen to me.

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    Quote Originally Posted by ffscm72 View Post
    ur missing a couple.
    Then by all means, please share with the rest of us. It was not my intent to create an all inclusive list and apparently forgot to note that.

    why make it deeper than it is? it just makes the job harder.
    Why make it more shallow than it is?

    How does acknowledging that the actual job of a Paramedic is different than that of an EMT because it involves additional training, diagnostic equipment, treatment options and medications make the job "harder"?

    I'm using the term EMT as the acronym. it precedes the level. I can see why we go back and forth on it...lol no biggy
    Then you might be the only one doing so.

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    Quote Originally Posted by FireMedic049 View Post
    Then by all means, please share with the rest of us. It was not my intent to create an all inclusive list and apparently forgot to note that.
    doing something as simple as head tilt chin lift? basic as it is, & again OPA/NPA. They aren't the best of solutions but in a pinch and that's all you had. they work.


    Why make it more shallow than it is?

    How does acknowledging that the actual job of a Paramedic is different than that of an EMT because it involves additional training, diagnostic equipment, treatment options and medications make the job "harder"?
    As far as level of complexity...yes you're right, Medics have BLS beat by a LOOOONG shot. But the job itself is the same. Still limited to what you can & can't do. Be proud, but when someones pride becomes more than they can handle then they start making mistakes. sometimes life threatening. Daring to go beyond their scope of practice w/o the proper education or skills to do so.

    Then you might be the only one doing so.
    then I like being the only one doing it correctly
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    Quote Originally Posted by ffscm72 View Post
    doing something as simple as head tilt chin lift? basic as it is, & again OPA/NPA. They aren't the best of solutions but in a pinch and that's all you had. they work.
    Sorry, but those don't count. What you seem to not be grasping is the importance of one key word in this part of the discussion. A word that I've highlighted and underlined multiple times - "secure".

    The head tilt, chin lift and OPA/NPA can certainly be used to open the airway, but they don't secure it and that's what you don't seem to be grasping.

    If the patient can aspirate his/her stomach contents, then the airway has not been secured.

    As far as level of complexity...yes you're right, Medics have BLS beat by a LOOOONG shot. But the job itself is the same. Still limited to what you can & can't do. Be proud, but when someones pride becomes more than they can handle then they start making mistakes. sometimes life threatening. Daring to go beyond their scope of practice w/o the proper education or skills to do so.
    I'm really not sure why you are having such a hard time accepting that EMT and Paramedic are not the same job. You seem to be able to grasp that there is a difference, but don't seem to be able to accept that this translates into them being different jobs. At this point, either you are extremely obtuse or you're a (insert your favorite derogatory term).

    This isn't about "pride". This isn't about going beyond the scope of practice. This isn't about any of the other BS you've spewed in this thread. This is simply black and white fact that they are different jobs. To view them in such overly broad simplistic terms (as a Fire/EMS provider), to be "the same job" is as disrespectful and ignorant as the public still referring to EMS providers as "ambulance drivers".



    then I like being the only one doing it correctly
    Well, I guess that's one way to look at it.

  6. #181
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    [QUOTE=FireMedic049;1284730]Sorry, but those don't count. What you seem to not be grasping is the importance of one key word in this part of the discussion. A word that I've highlighted and underlined multiple times - "secure".

    The head tilt, chin lift and OPA/NPA can certainly be used to open the airway, but they don't secure it and that's what you don't seem to be grasping.

    If the patient can aspirate his/her stomach contents, then the airway has not been secured.[quote]
    it opens the airway. if that all you got, then that's all you got.

    I'm really not sure why you are having such a hard time accepting that EMT and Paramedic are not the same job. You seem to be able to grasp that there is a difference, but don't seem to be able to accept that this translates into them being different jobs. At this point, either you are extremely obtuse or you're a (insert your favorite derogatory term).
    I'm not really sure why you can't grasp the reality that you are an E.M.T. If you want to be more than, then by all means please do so. Otherwise your job is the same as mine assess, treat, transport. You've got more tools at your disposal obviously. But the job is the same. I repeat so you can understand Assess the signs & symptoms as they present (with me so far), treat the signs & symptoms within your local protocols (write this down), transport the patient so a higher level of care can possibly find the cause of the signs & symptoms (there is a test after this)

    Test time:
    Your job as an E.M.T is:
    a.)assess, treat, transport
    b.)assess, treat, transport
    c.)assess, treat, transport
    d.) all of the above

    This isn't about "pride". This isn't about going beyond the scope of practice. This isn't about any of the other BS you've spewed in this thread. This is simply black and white fact that they are different jobs. To view them in such overly broad simplistic terms (as a Fire/EMS provider), to be "the same job" is as disrespectful and ignorant as the public still referring to EMS providers as "ambulance drivers".
    Apparently this is about pride for you or you wouldn't be adamant about showing off the amount of skills you have instead of just accepting that "yes, although our skills are at different levels, we still are just here to aid the patient w/ what we are given."

    To not view EMS in it's simplest form is arrogant & eventually stupid.
    I believe i'm about done w/ this thread being we are just going back & forth w/ no end in sight...lol So I will leave w/ this.

    Even though we don't agree on this, I can only hope you stay safe & sound.
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  7. #182
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    Quote Originally Posted by ffscm72 View Post
    Test time:
    Your job as an E.M.T is:
    a.)assess, treat, transport
    b.)assess, treat, transport
    c.)assess, treat, transport
    d.) all of the above
    In New Jersey (for most medics) it would be

    e.) None of the above.

    They don't transport.

    So, let me ask my question again....

    You Assess and Treat a person for a nose bleed, you are:

    a.) EMT
    b.) Police Officer
    c.) Boy Scout
    d.) Security Guard
    e.) All of the above
    I am now a past chief and the views, opinions, and comments are mine and mine alone. I do not speak for any department or in any official capacity. Although, they would be smart to listen to me.

    "The last thing I want to do is hurt you. But it's still on the list."

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  8. #183
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    Quote Originally Posted by ChiefKN View Post
    In New Jersey (for most medics) it would be

    e.) None of the above.

    They don't transport.

    So, let me ask my question again....

    You Assess and Treat a person for a nose bleed, you are:

    a.) EMT
    b.) Police Officer
    c.) Boy Scout
    d.) Security Guard
    e.) All of the above
    Don't transport? I'm confused.
    Get the first line into operation.

  9. #184
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    [QUOTE=ffscm72;1284766][QUOTE=FireMedic049;1284730]Sorry, but those don't count. What you seem to not be grasping is the importance of one key word in this part of the discussion. A word that I've highlighted and underlined multiple times - "secure".

    The head tilt, chin lift and OPA/NPA can certainly be used to open the airway, but they don't secure it and that's what you don't seem to be grasping.

    If the patient can aspirate his/her stomach contents, then the airway has not been secured.
    it opens the airway. if that all you got, then that's all you got.



    I'm not really sure why you can't grasp the reality that you are an E.M.T. If you want to be more than, then by all means please do so. Otherwise your job is the same as mine assess, treat, transport. You've got more tools at your disposal obviously. But the job is the same. I repeat so you can understand Assess the signs & symptoms as they present (with me so far), treat the signs & symptoms within your local protocols (write this down), transport the patient so a higher level of care can possibly find the cause of the signs & symptoms (there is a test after this)

    Test time:
    Your job as an E.M.T is:
    a.)assess, treat, transport
    b.)assess, treat, transport
    c.)assess, treat, transport
    d.) all of the above



    Apparently this is about pride for you or you wouldn't be adamant about showing off the amount of skills you have instead of just accepting that "yes, although our skills are at different levels, we still are just here to aid the patient w/ what we are given."

    To not view EMS in it's simplest form is arrogant & eventually stupid.
    I believe i'm about done w/ this thread being we are just going back & forth w/ no end in sight...lol So I will leave w/ this.

    Even though we don't agree on this, I can only hope you stay safe & sound.
    Brother I have tried to agree with you on some things and disagreed on some others, but if you believe EMS is simple and anyone can do it than you must be in one great area. We aren't just here to aid the pt like I just put a band aid on my 4 y/o knees from falling off his bike. I had a young lady just last night od on herion, bls got on scene and found her in cardiac arrest. They started CPR and threw in a king airway, they then called for ALS and beat foot down the road. We met them and started ALS care, after 2 mg of narcan she pulled the airway and was talking and ready to refuse by the time we got the ED. In your above statement you said that we transport so the ER doctor can find the cause of the signs and symptoms, I corrected the symptoms in the field, I love the bls crew we met and have great friends on their service, but if an ALS crew would not have intercepted them this young lady would be dead. So keep saying we have the same job, it is not the same my friend.

  10. #185
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    Quote Originally Posted by ffscm72 View Post
    To not view EMS in it's simplest form is arrogant & eventually stupid.
    If that's the case, why do we attend fire service seminars, training events, webinars, websites, read magazine, read books, view videos, get new certifications, and listen to the fire service leaders? Shouldn't we just be content just viewing the fire service "in it's simplest form" and not worry about the rest of the hazards we face?

    What's the difference between fire & EMS in this case?
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  11. #186
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    Quote Originally Posted by L-Webb View Post
    Don't transport? I'm confused.
    In New Jersey it is a relatively new thing that our Paramedics transport. In most cases, they respond in an SUV and ride along with the BLS (who transport).

    So, they don't transport.
    I am now a past chief and the views, opinions, and comments are mine and mine alone. I do not speak for any department or in any official capacity. Although, they would be smart to listen to me.

    "The last thing I want to do is hurt you. But it's still on the list."

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  12. #187
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    Quote Originally Posted by ChiefKN View Post
    In New Jersey it is a relatively new thing that our Paramedics transport. In most cases, they respond in an SUV and ride along with the BLS (who transport).

    So, they don't transport.
    Got it. There are some places here that do that as well
    Get the first line into operation.

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    In NY paramedics don't transport - they let the ambulance do that.

    They do, however, treat the patients being transported in those ambulances.

    In my area, ambulances are usually staffed at the highest level available - the gold standard being paramedic, of course. No commercial ambulance service worth its salt staffs ambulances with anything less than one paramedic. The second crew member may be another paramedic, or some lower level. Most busy vollie/combination squads are the same - especially those who staff crews in-house.

    If it's a BLS call, the paramedic often leaves treatment to the EMT and drives the rig to the hospital.

    If a patient requires a higher level of care than what the crew on board can provide, they call for a hook-up with the suitable level - generally a paramedic.

    Not all of our squads are certified for narcotics, regardless of their level of care, so some hook-ups are for pain meds or Valium.
    Opinions my own. Standard disclaimers apply.

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    Quote Originally Posted by ffscm72 View Post
    Quote Originally Posted by FireMedic049 View Post
    Sorry, but those don't count. What you seem to not be grasping is the importance of one key word in this part of the discussion. A word that I've highlighted and underlined multiple times - "secure".

    The head tilt, chin lift and OPA/NPA can certainly be used to open the airway, but they don't secure it and that's what you don't seem to be grasping.

    If the patient can aspirate his/her stomach contents, then the airway has not been secured.
    it opens the airway. if that all you got, then that's all you got.
    But that's not even being disputed. The question was about SECURING the airway not opening it.



    I'm not really sure why you can't grasp the reality that you are an E.M.T. If you want to be more than, then by all means please do so.
    Maybe it's because the reality is that I'm not an "E.M.T." I just looked at my certification card from my state and it says that I'm a "PARAMEDIC". No where on the card does it say "EMT" or "Emergency Medical Technician". So, I guess that means I'm already "more" than an "E.M.T.".

    Otherwise your job is the same as mine assess, treat, transport. You've got more tools at your disposal obviously. But the job is the same. I repeat so you can understand Assess the signs & symptoms as they present (with me so far), treat the signs & symptoms within your local protocols (write this down), transport the patient so a higher level of care can possibly find the cause of the signs & symptoms (there is a test after this)

    Test time:
    Your job as an E.M.T is:
    a.)assess, treat, transport
    b.)assess, treat, transport
    c.)assess, treat, transport
    d.) all of the above
    Blah, Blah, Blah, Blah



    Apparently this is about pride for you or you wouldn't be adamant about showing off the amount of skills you have instead of just accepting that "yes, although our skills are at different levels, we still are just here to aid the patient w/ what we are given."
    No, this isn't about "pride" for me. This is about "ignorance" - YOUR ignorance!

    To not view EMS in it's simplest form is arrogant & eventually stupid.
    Then I'll happily be "arrogant & eventually stupid" rather than be what you are!

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    Default Repost. I think it was missed.

    Quote Originally Posted by ffscm72 View Post
    Test time:
    Your job as an E.M.T is:
    a.)assess, treat, transport
    b.)assess, treat, transport
    c.)assess, treat, transport
    d.) all of the above
    In New Jersey (for most medics) it would be

    e.) None of the above.

    They don't transport.

    So, let me ask my question again....

    You Assess and Treat a person for a nose bleed, you are:

    a.) EMT
    b.) Police Officer
    c.) Boy Scout
    d.) Security Guard
    e.) All of the above
    I am now a past chief and the views, opinions, and comments are mine and mine alone. I do not speak for any department or in any official capacity. Although, they would be smart to listen to me.

    "The last thing I want to do is hurt you. But it's still on the list."

    "When tempted to fight fire with fire, remember that the Fire Department usually uses water."

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