Medics a question for you

[realist]

Hey is there any one into TEMS out there? I’m looking for good TEMS classes. Preferably out here in the west but if not, then I will travel.

I was supposed to take an EMT class last semester but I screwed up and did not register in time. So I managed to get in this semester. Needless to say it is a lot of work. It has been a while since I took a semester long class. My goal is to get through the EMT class and then go on to a TEMS class. I guess I am trying to see if it is going to be worth it? I thought about going the paramedic route however I am not looking for a job so I think that would be a little much and I’m too fricking old. However I may reconsider after the semester is over. I’m looking for the most bang for the buck I guess.

My time is pretty limited. Right now I’m working 40 hours a week and teaching 4 to 12 hours a week also. I have had to put some of my volunteer stuff on hold due to the class. For my class I had to dig out my old records, I originally went through the EMT cert in 1982. To add insult to injury when I handed it in to our squad leader he made the comment he was born 10 years after I went through the first course.

Soooooooo if you have any recommendations I would appreciate it. Thanks in advance…..

[ElevenBravo]

I certed NREMT-A in '84 so dont feel too bad...
EB

[realist]

Elevenbravo I don't know if you kept up on your skills but there have been a lot of changes since then. That is the main reason why I am taking the class. I highly recommend you check into what has changed. It sucks but it is good material.

[apssbc]

Things have changed a lot since the eighties. I have TEMS training, however I'm not part of a team since my agency is not part of a swat medic team. This is a goal I am still working on, and would be the highlight of my career. Its well worth taking just for the knowledge but usually is a very good course. Out west you actually have more options for Tac Medic classes than we do out here. Just google search it.

[ElevenBravo]

there have been a lot of changes since then

Im sure there has, but no disrespect sir...

"Air goes in and out, blood goes round and round.... anything that inhibits that is bad" will always stay true no matter the decade.

Im pretty sure the skillz I had then would be just as effective today. Sure, there are NEW skills... but in my view that does not make the old skills any less legitimate or valuable.

I for one, got to see how effective MAST were, Ive seen them keep a guy alive until we got to the ER, however... somehow... today, MAST are a "thing of the past". Just because a new product or author steps onto the stage doesnt make "older" stuff usless.

Now, were talking MODERN medicine, I can see someone making comparison to now and civil war times. Obviously, THAT is a large break in time. Though then too, air in out blood round round was still a golden rule, weather they knew it or not. :-)

EB

[Fidel MD]

A lot of what was taught as trauma care in the military in the 80's is frankly, bad advice today. The change started during and after Desert Storm, when people started using evidence based medicine to analyze what was being taught and done.

For example, every trauma patient doesn't need an IV, and some of them shouldn't get one, at least until bleeding is controlled. All putting more fluid into a leaking pipe system does is wash out more blood, and the limited number of blood clotting factors available at any one time. Current best practice is to control bleeding first, using a bandage, wrap, hemostatic agent, and modern tourniquet (not the pos tourniquet, non-pneumatic, 1 ea that was issued through the 90's), then assess the patient - if he's mentating adequately (not acting goofy) he doesnt need an IV, just a saline lock so that if he does need an IV he can get it quickly. During the Blackhawk Down event, the highly trained ranger and PJ medics flushed a lot of blood out into the streets of Mogadishu, and then when the patients REALLY needed the support for their blood pressure, the cupboards were bare and resupply not happening. Thats not supposed to happen any more.

The idea of a combat pill pack is newish, and the contents have changed a few times over the last 15 years, too.

While it's true that air goes in and out, and blood goes round and round, a LOT of what was taught actually prevented that from happening. TCCC (tactical combat casualty care) evolves, just like science is supposed to.

[piranha2]

Thats why they call it "Practicing medicine."

[Fidel MD]

Thats why they call it "Practicing medicine."

Still an art, as much as science. And I'm still learning.

But these days, it's "Evidence Based Medicine" all the way. Even commonly accepted treatments are tested to see if they really work.

[ladyhk13]

I certed NREMT-A in '84 so dont feel too bad...
EB

Mine was in '79 so boy do I feel old......

[ditchmedic]

Still an art, as much as science. And I'm still learning.

But these days, it's "Evidence Based Medicine" all the way. Even commonly accepted treatments are tested to see if they really work.

Ever evolving. I've only been in emergency medicine for two years, but when I came in to it, if you told me "one day Epi may be obsolete in cardiac arrest I would have called you crazy.

I was taught trauma gets a backboard, c-collar and head blocks.

Now my company ( mainly my shop) will be one of the first in the nation to remove epi from the cardiac arrest algorithm and using backboards for moving only.

[ladyhk13]

No epi?? Now that's just terrible!

[Twitchy]

Ever evolving. I've only been in emergency medicine for two years, but when I came in to it, if you told me "one day Epi may be obsolete in cardiac arrest I would have called you crazy.

I was taught trauma gets a backboard, c-collar and head blocks.

Now my company ( mainly my shop) will be one of the first in the nation to remove epi from the cardiac arrest algorithm and using backboards for moving only.

I know the basis on why boards are being removed, however I still believe they have their place in certain situations...

Why is epi being removed from the cardiac algorithm?

[ditchmedic]

I know the basis on why boards are being removed, however I still believe they have their place in certain situations...

Why is epi being removed from the cardiac algorithm?

There is no evidence of effectiveness to discharge. You probably havent heard the term "epi induced rythm" yet. Epi is good at ROSC but with a half life of about 2 minutes it doesn't last. Im sure if they havent already your employer will be focusing more on effective CPR.

I work for the big bad private company so we are consistently at the forefront of practicing evidence based medicine.





Google "Calloway epi study" for more info.

[Twitchy]

There is no evidence of effectiveness to discharge. You probably havent heard the term "epi induced rythm" yet. Epi is good at ROSC but with a half life of about 2 minutes it doesn't last. Im sure if they havent already your employer will be focusing more on effective CPR.

I work for the big bad private company so we are consistently at the forefront of practicing evidence based medicine.





Google "Calloway epi study" for more info.

ah... Thanks for the info, I'll be reading up on this for sure!