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In a message dated 9/16/00 7:21:45 AM Pacific Daylight Time,

band_aid27@... writes:

<< I don't think its the schools that are the problem,

its the individuals attending these schools. If you

want to be proficient in your skills, practice. If

you need someone to keep poking you in the back to

make you practice, well, that doesn't say much for

initiative. I'm a paramedic student now and am

looking foward to learning new and more advanced

skills but I'm not going to expect my instructors to

make me a pro, I expect that from myself. They just

better show me the correct way!!! I strongly believe

school is what you make of it, whether its a

" mass-production " or not. Practice, practice, practice

and when you're done, practice some more.

Rene Fernandez

EMT-Basic

Secure Care Ambulance >>

Rene,

I couldn't agree with you more. I urge my students to practice. I tell them

to take their wife's, husband's, children's, mother's, father's, friend's,

etc. vital signs over and over again while they are learning. Only through

repitition and practice will they become proficient in this area. Thank you

for your input and viewpoint as a upcoming EMS provider!

, BS, LP

Instructor

Emergency Medical Services Profession Program

Tyler Junior College

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I don't think its the schools that are the problem,

its the individuals attending these schools. If you

want to be proficient in your skills, practice. If

you need someone to keep poking you in the back to

make you practice, well, that doesn't say much for

initiative. I'm a paramedic student now and am

looking foward to learning new and more advanced

skills but I'm not going to expect my instructors to

make me a pro, I expect that from myself. They just

better show me the correct way!!! I strongly believe

school is what you make of it, whether its a

" mass-production " or not. Practice, practice, practice

and when you're done, practice some more.

Rene Fernandez

EMT-Basic

Secure Care Ambulance

--- wrote:

> I have to admit, I was one of those paramedic

> students who could not take a

> blood pressure very well. A big part of that problem

> was that I allowed

> myself to be spoiled. The FD I volunteered with as

> an EMT used pro-packs and

> I was used to push-button blood pressures. The only

> manual blood pressure I

> had ever taken was to test the skill in EMT school.

> It took some practice,

> but I no longer have any difficulty with manual

> blood pressures.

>

> The problem with most of the paramedic problems is

> that they don't usually

> do the re-test in the Basic skills until late in the

> program. EMT schools on

> the other hand (or it seems so in this area) only

> mass-produce EMTs and

> don't really do much in the way of skills practice

> nor do they seem overly

> concerned with the quality of EMT they turn out.

> Most schools rely on the

> services to train their people, all the school is

> there for is to get that

> person a patch.

>

> Now, I am not saying all schools are this way. I'm

> just saying that these

> schools exist and this is a problem.

>

>

__________________________________________________

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It is not good enough to rely upon a single checkoff on bloodpressure taking.

After that, students must be continuously monitored and given opportunities

to do BPs on " real " patients in the scenario setting. When you do your

scenarios, never let them ask " What's BP. " Make them take the BP of the

student who is playing the role of the patient and report what they actually

get. Then you can tell them what the scenario BP is. This way they get to

practice it in noisy environments and under all sorts of conditions. We're

lucky enough to have two ambulances for use in our program, and we must

always remember to let students practice in the moving truck. Instructors

must monitor the " patients " also to be sure the BP being reported is

accurate.

Again, NO ONE CHECKOFF is reliable. Serial demonstrations of every skill

that can be simulated is required.

Gene Gandy

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who said that you had to use the machine to do the work, they are sometimes

really not that accurate. i would rather hear it and know that, that is the

BP i got than trust the machine. i believe that if you are having problems

with your skills then you need to ask for help. when that machine breaks

down you will have to rely on your training to do your job dont always rely

on it to get you out of a pinch. just ask for help and work to better your

skills if that is what needs to be done.

i think that its the students who are relying on high tech gagets that are

out there to get them throught it all. the schools are teaching the skills

needed for them to do the jobs and then when they (the students) find

employement they are finding the neat gadgets and gizmos that make the job

easier and more effecient and are forgetting the basic things that they were

taught. just so it doenst seem like im throwing out stones at all students

or anything like that im saying there are a few out there that do that.

skills practice and continuing ed are the keys to keeping our people well

trained and up to date.

Randy Dees

EMT-P

[texasems-L] Blood pressures

>

> I have to admit, I was one of those paramedic students who could not take

a

> blood pressure very well. A big part of that problem was that I allowed

> myself to be spoiled. The FD I volunteered with as an EMT used pro-packs

and

> I was used to push-button blood pressures. The only manual blood pressure

I

> had ever taken was to test the skill in EMT school. It took some practice,

> but I no longer have any difficulty with manual blood pressures.

>

> The problem with most of the paramedic problems is that they don't usually

> do the re-test in the Basic skills until late in the program. EMT schools

on

> the other hand (or it seems so in this area) only mass-produce EMTs and

> don't really do much in the way of skills practice nor do they seem overly

> concerned with the quality of EMT they turn out. Most schools rely on the

> services to train their people, all the school is there for is to get that

> person a patch.

>

> Now, I am not saying all schools are this way. I'm just saying that these

> schools exist and this is a problem.

>

>

>

>

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When I got my EMT at TCC, I think Steve had us document vitals (w/ only

manual BPs) on over 100 people that had to be turned in during our skills

testing at the end of the semester. I've had students doing rotations in

the ERs where I've worked and don't want to do manual BPs, but I insist that

each and every one they do is manual. One student got mad at me because the

family and I were talking while he was taking the BP - I asked him if he was

working an MVA, did he think everyone was going to be quiet while he got his

vital signs? They usually realize before it's over how necessary it is to

take many so that when they're on the ambulance, they are fairly competent.

But, as says, practice, practice, and practice!

Take care, stay safe, and practice mercy, ya'll!!

Jana

FW,TX

Re: [texasems-L] Blood pressures

>

> In a message dated 9/16/00 7:21:45 AM Pacific Daylight Time,

> band_aid27@... writes:

>

> << I don't think its the schools that are the problem,

> its the individuals attending these schools. If you

> want to be proficient in your skills, practice. If

> you need someone to keep poking you in the back to

> make you practice, well, that doesn't say much for

> initiative. I'm a paramedic student now and am

> looking foward to learning new and more advanced

> skills but I'm not going to expect my instructors to

> make me a pro, I expect that from myself. They just

> better show me the correct way!!! I strongly believe

> school is what you make of it, whether its a

> " mass-production " or not. Practice, practice, practice

> and when you're done, practice some more.

>

> Rene Fernandez

> EMT-Basic

> Secure Care Ambulance >>

>

> Rene,

>

> I couldn't agree with you more. I urge my students to practice. I tell

them

> to take their wife's, husband's, children's, mother's, father's, friend's,

> etc. vital signs over and over again while they are learning. Only

through

> repitition and practice will they become proficient in this area. Thank

you

> for your input and viewpoint as a upcoming EMS provider!

>

> , BS, LP

> Instructor

> Emergency Medical Services Profession Program

> Tyler Junior College

>

>

>

__________________________________________________

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Jana,

The more students practice taking vital signs the more comfortable they will

be in taking them. As you know, there are some students that have a hard

time hearing a BP, those are the ones that you have to work with at times.

Trying different steths, etc.

It is hard to hear BPs in a moving truck and on scene at times. These are

things that students are going to have to get use to, because all scenes are

not going to be quiet.

Every instructor should make their students get at least 100 sets of V/S

before the end of class or before they start rotations. One thing that

someone pointed out, was to go to the local nursing home and have students

take V/S there.

Wayne

Re: [texasems-L] Blood pressures

>

>

> >

> > In a message dated 9/16/00 7:21:45 AM Pacific Daylight Time,

> > band_aid27@... writes:

> >

> > << I don't think its the schools that are the problem,

> > its the individuals attending these schools. If you

> > want to be proficient in your skills, practice. If

> > you need someone to keep poking you in the back to

> > make you practice, well, that doesn't say much for

> > initiative. I'm a paramedic student now and am

> > looking foward to learning new and more advanced

> > skills but I'm not going to expect my instructors to

> > make me a pro, I expect that from myself. They just

> > better show me the correct way!!! I strongly believe

> > school is what you make of it, whether its a

> > " mass-production " or not. Practice, practice, practice

> > and when you're done, practice some more.

> >

> > Rene Fernandez

> > EMT-Basic

> > Secure Care Ambulance >>

> >

> > Rene,

> >

> > I couldn't agree with you more. I urge my students to practice. I tell

> them

> > to take their wife's, husband's, children's, mother's, father's,

friend's,

> > etc. vital signs over and over again while they are learning. Only

> through

> > repitition and practice will they become proficient in this area. Thank

> you

> > for your input and viewpoint as a upcoming EMS provider!

> >

> > , BS, LP

> > Instructor

> > Emergency Medical Services Profession Program

> > Tyler Junior College

> >

> >

> >

>

>

> __________________________________________________

>

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Absolutely, I agree 100%! That's one reason that in the ER, I want them to

take manuals because it gives them practice in a little better situation

than on the scene of an accident or in the ambulance. But, we all know

this, so how do we convince the students how important it is!?!

Take care, stay safe, and practice mercy, ya'll!!

Jana

FW,TX

Re: [texasems-L] Blood pressures

> >

> >

> > >

> > > In a message dated 9/16/00 7:21:45 AM Pacific Daylight Time,

> > > band_aid27@... writes:

> > >

> > > << I don't think its the schools that are the problem,

> > > its the individuals attending these schools. If you

> > > want to be proficient in your skills, practice. If

> > > you need someone to keep poking you in the back to

> > > make you practice, well, that doesn't say much for

> > > initiative. I'm a paramedic student now and am

> > > looking foward to learning new and more advanced

> > > skills but I'm not going to expect my instructors to

> > > make me a pro, I expect that from myself. They just

> > > better show me the correct way!!! I strongly believe

> > > school is what you make of it, whether its a

> > > " mass-production " or not. Practice, practice, practice

> > > and when you're done, practice some more.

> > >

> > > Rene Fernandez

> > > EMT-Basic

> > > Secure Care Ambulance >>

> > >

> > > Rene,

> > >

> > > I couldn't agree with you more. I urge my students to practice. I

tell

> > them

> > > to take their wife's, husband's, children's, mother's, father's,

> friend's,

> > > etc. vital signs over and over again while they are learning. Only

> > through

> > > repitition and practice will they become proficient in this area.

Thank

> > you

> > > for your input and viewpoint as a upcoming EMS provider!

> > >

> > > , BS, LP

> > > Instructor

> > > Emergency Medical Services Profession Program

> > > Tyler Junior College

> > >

> > >

> > >

> >

> >

> > __________________________________________________

> >

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About those BP machines. They suck. Period. Never had an accurate reading in

a moving unit yet. Ever.

The following is a 'war story' to point out how useless/deadly the durn

things are:

Once upon a time I worked for a service in a small Texas town. I got called

to the Hospital to pick up a patient for transfer to a larger Texas town.

Now I had picked the patient up at her home earlier in the day and she was

suffering (at the time of pick-up) from symptomatic bradycardia which was

relieved with Atropine (don't ask for all the details, it has been a couple

of years and I don't remember all the particulars). So I put on my uniform

and head to the hospital to take this patient elsewhere.

Upon arrival I find the patient supine on the hospital bed with an external

pacemaker hooked up and keeping her pulse >60. The patient is twitching

away. She is also pale, diaphoretic, unresponsive, and breathing at 10 times

a minute. She has nitropaste and NTG drip going because, " We hooked her up

to the pacemaker and she became hypertensive. " I looked at the MD, the RN,

and the 2 Paramedic students and opened my mouth. I then shut my mouth,

said, " Right " tossed the patient onto my cot and bolted for my ambulance.

I put the patient in my unit and told my partner, " Drive like hell " . Once in

the unit I got a manual BP of 60/p. I proceeded to trendelenburg the

patient, remove the nitropaste, turn off the NTG drip, bolus her with 500cc

NS and hang a Dopamine drip. I also PUT HER ON OXYGEN. I then called the

RECIEVING facility and got permission to do some other stuff.

Why was this patient FUBAR? The stupid machine detects the miniscule change

in pressure of blood rushing through the arteries in the arm. It is fooled

by such things as muscle twitching. What happens when you pace someone?

That's right, they twitch.

NO ONE noticed that the patient was deteriorating in her mental status. NO

ONE noticed that the patient had a crappy O2 sat. NO ONE noticed anything

but the damn machine.

So, if you are using a BP machine in your unit, only trust it AFTER you get

a manual BP. And don't do ANY treatments until AFTER you manually check

stuff.

And yes, I tried making a suggestion that things weren't right to both the

MD and the RN and got told I was a stupid Paramedic who didn't know nothing

and I should shut up and transport the patient.

Webb, LP

FLW EMS, MO

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