-=> Quoting George Vaisey to All <=-
 GV> I passed my EMT w/flying colors.  I'm now state certified!   NYS EMT
 GV> #223855.
 GV> George Vaisey
Gee, you got high registration numbers over there! Congrats, George.
Your certification to EMT is a START in the profession. Certainly a
milestone, but read on. You'll see
Down here in Arizona, you are required to be EMT certified through the
junior college system BEFORE ever hiring on to a fire department now.
Too many wannabes out there. The course in 1986 used to cost $95
including malpractice insurance. Today, the same course is $245 plus
another $225 for malpractice, AND you have to present PROOF of MMR
vaccinations/DPT shots/Tetanus boosters/polio vaccine, and NOW the HEP B
vaccinations at OUR own cost. When something can't be proved, then you
have to have bloodwork to show that you have antigen positives to
measles, mumps, rubela, rubeola, polio, diptheria, tetanus, chicken pox,
and hepatitis B. All that can amount to a few hundred dollars more. The
Hep B series is $195 alone.  Back then, no health insurance paid
for Hep B unless you are in a profession that requires it. My HMO gave
me mine because they operate on a different premise - an ounce of
prevention is worth a pound of cure and of course, *state law* mandated
it. Today, Hep B vaccine is to be included in the standard course for
babies because of diapers, etc.
When I passed my first EMT certification in '86 with a score of 97% and
was the first one out the door in 20 minutes after a 150 question exam,
I was elated. As time goes by, standards get tougher and more strict.
Then the NR (National Registry) version was implemented as the "gold
standard" 2 years ago. Before that, we had to RECERTIFY every 2 years. I
never scored below 91 all those years.
Then they went to state EMT recertify every 4 years and NR every 2
years. This stupid state made the NR the "gold standard" for BOTH the
state certification and NR. The only difference is the time lapse
between recertifications! If we wanted NREMT, we test every 2 years
with a 2 weekend NR refresher class of 2 credits.
If we want EMT, then it's every 4 years with a 2 weekend NR refresher
class of 2 credits, and the NREMT exam. We have to get a new CPR card at
the new AHA Health Care Provider certification every 2 years along with
a newly issued EMT card. In essence we have to get a new EMT card every
2 years, but recertify every 4 years.
They only issue AHA CPR cards for 2 years only. That's why it's so
wierd. On the back of the EMT license ID card, it says INVALID WITHOUT
PROOF OF CURRENT BCLS/ACLS CERTIFICATION. On the front it has a space
for photo insertion and then it's laminated into a plastic card. I just
have to get ACLS/Health Care Provider renewal by 1/27/97 and send the
paperwork and check in. Then I get a new card in the mail. Looks like my
holiday season for 1998 will be spent doing NR studying.
My first NREMT was tough - all case based scenarios. I scored an 88 on
the NR, was the third to last person out of the room and took the whole
alotted time span. The state exam was more gentle because it just
focuses on the A, B, C's and you get an odd question here or there. Just
remember - don't ever let your certification lapse. In Arizona, you have
30 days to recertify after the expiration date and if you don't, you
have to go back to EMT101 and take the whole 7 credit hour course all
over again!!!! AAAAGGGGHHHH!
When they started enforcing the EMT requirement as being a condition of
employment for the fire depts in 1990, we found out who was illiterate!!
We had a hispanic fellow firefighter who put in 23 years into the FD. He
never did make any attempts at promotions. Firefighter for 23 years (Now
it's 30)! Now we knew that he had hid his shame from us for so long. We
all helped him to pass the state certification exam by Q/A. He made an
request to the DHS to have it administered orally in English. They
granted the orals. He scored well. The state granted him his first EMT
certification. We are very proud of him. Nothing else defines the bonds
of the "closed clique" of friendship of firefighters better than this.
People have always sensed a special "bond" of a firehouse crew. This
event also made local news in the newspaper when it happened.
One of my buddies, a NREMT-P (Bob) was on a trip to Ohio with the dept
chairperson (R.N. and doctorate in nursing - Kay) to work on the NR
council this spring. A gentleman on the DC-10 had a heart attack in
flight. Bob and Kay were the only medical personnel on board. The
passenger passed out, vomited, aspirated it, etc. They were flying
INTERSTATE from AZ to OH. It happened over Missouri. Kay did the
ALS/CPR with the man on his back spanning the 5 seats in the center, and
Bob asked the pilot to patch into the nearest hospital in St. Louis.
This is where the NR came into play - VERY IMPORTANT CONCEPT HERE. When
the pilot asked for any medical providers, Kay's R.N./Instructor Level
CPR id was provided, and Bob's NREMT-P/CPR id were provided to the
pilots. Legally speaking, Kay's credentials were only valid in/over
Arizona only. Bob's credentials were valid NATIONWIDE. If a doctor had
been on board and he was not licensed in Missouri, the NREMT-P (Bob) has
precedence over the doctor. These are airline SOPs. The doctor can
ASSIST, but the NREMT-P has legal control of the scene. Most states
acknowledge the NR credentials now. Therefore, Bob had legal
jurisdiction in Missouri since he was NR certified and was in the
cockpit following protocol on the radio patch. He always keeps a small,
but necessary kit with him at all times so he can help cardiac patients
with IV's, drugs, etc. He patched to a St. Louis hospital, where the
base E/R issued orders (standing orders differ from hospital to
hospital to EMS providers) and the plane landed in St. Louis where an
ambulance was waiting on the runway. The passenger was unloaded,
control passed from Bob to the local paramedics and they took off again
for Ohio. The hospital replenished the consumables from Bob's kit and
the airline's kit. I also keep a small kit handy at all times as well,
but with no drugs or IV's. I'm not certified to provide ALS service,
being an EMT, just BLS. EMT-P or NREMT-P are certified to provide ALS
service.
The whole plane gave the both of them a standing ovation when the pilot
explained what happened (without disclosing names). Not only that, the
both of them got their tickets refunded for this entire round trip
flight, and each got 5 round trip first class tickets to anywhere in the
USA. Passengers tried to get more information from Kay and Bob, only to
be told, "I cannot disclose any information, it violates patient/health
care provider confidentiality". TRUE. Now you will see that an NR
certification will allow you to practice in almost all of the 50 states.
Therefore, recertification and retraining are a must to keep up with the
changes in healthcare. Each time I have done a CPR recert, it has been
updated with new information provided. Now the NR is about to issue
changes to the NREMT level. NREMT's will now be allowed to do IV's, the
more simple computerized cardiac monitoring/shock machines, where
available, and intubation. They also will be able to do very limited
pharmacology - insulin, epinepherine, nitroglycerin, syrup of ipecac,
narcan, D5W, Ringers, etc. This frees  up the paramedic to take on more
complex tasks of street medicine. I welcome all the changes of pushing
down the most easiest tasks of paramedic's training.
I've illustrated why I said that your first EMT cert was a "start" in
the field of street medicine. Eventually you will use all your skills in
patient stabilization and getting a patient to an E/R no matter where
you are and what you're doing. Next time, go for the gold standard. I
am.
John
FF/EMT #31098/Arizona
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