-=> Quoting Blake Bowers to John Simmons <=-
 JS> I'm sorry that you feel that you have been insulted. It is YOUR state
 JS> DHS that's been insulting YOU, by requiring their standards be higher
 JS> than the National Registry Testing!! This happens when your state
 BB> Huh?  Actually, states that require a higher level, are just raising
 BB> the  level of professionalism in that state.
 BB> Just a little better than all the rest....
For what reason? At whose gain? How does that benefit you? More pay?
 JS> Dept of Health Services, including many states where there is little
 JS> or no cooperation between the EMS providers and DHS bureaucracy, who
 JS> really have no idea of what street medicine really is all about.
 BB> Chuckle.  TN for one, does not see much of that.  All of the people in
 BB> the State office of Emergency Medical Services have seen the streets,
 BB> even down to most of the clerical staff.  Damn good at it also!
 JS> abolished. The community colleges (teaching and testing) and the state
 JS> fire marshall's office (licensing) would then have control - where it
 JS> really belongs.
 BB> TN has been that way for years, albeit the state office of emergency
 BB> medical services does the licensing.  Where it really belongs.  We use
 BB> the fire marshall for fire related stuff, not medical.
Whatever it is, it's definitely a bureaucratic turf war, for sure. We're
not the only state that has that problem. It's spelled POLITICS. I just
stay the hell away from it.
 JS> Arizona does not have a standardized test and the NRT does and that is
 JS> why the state of Arizona is converting. By the year 2000, all of
 BB> Fine.  They should do so.  But other states that already have a
 BB> standardized test, and require a higher standard, should not be
 BB> required to LOWER THEIR STANDARDS to meet those of states WITHOUT THE
 BB> SAME LEVEL OF QUALITY CARE!
It sounds like perhaps you're in a hybrid position between NREMT and
NREMT-P, or perhaps EMT-I and EMT-P. This is the very problem. If you
are performing to a higher standard, a level should be established for
that standard nationwide to eliminate all the conglomerations of EMT add
ons that apply in one state, but not another. NR addresses that.
 JS> the NRT long term goals is to have the NRT replace ALL the states'
 JS> testing be standardized nationwide to the NRT level and establish new
 JS> guidelines and levels of care.
 BB> NRT, with all their money grubbing outlook, may have that goal.  Many
 BB> of us hope that goal is unobtainable for them.
Money? The NR is not money hungry. Yes, it's a $15 fee for the test, but
most people don't know that part of it goes to research and in the form
of block grants to community colleges needing funds to convert to the NR
standard. The NR is a non-profit committee seeking Federal Charter and I
can assure you, they don't pay well at all. It's mainly the dedication
and volunteerism that's making things happen. I set up a system to which
everyone on the NR committee bbs's to a common private forum. I guess by
now you can figure out that I'm involved with the NR committee also. I
was invited to on their breakfast meeting when they came down to Phoenix
last winter. These people know their stuff. All are doctors and
educators. I was impressed. They were impressed at how I could help them
attain their goals via daily communications at little or no cost and my
knowledge of all the contradictory standards that they were trying to
sort out.
 JS> You'd be surprised at how many lawsuits get filed against EMT's and
 JS> Paramedics for not DOING or FOLLOWING established PROTOCOL. This never
 JS> gets published in the papers much, but it's a big problem. The
 BB> Actually, although it does happen, the frequency is not near as much
 BB> as urban legend makes it out to be.
My brother is an attorney at a large insurance firm. You wouldn't
believe half the stuff people sue for regarding EMS if I told you. I was
quite surprised myself enough to ask, "What's wrong with this society?
What drives people to do utterly stupid things like this???" My brother
tells me things monthly of cases that go through his office.
Unbelievable sometimes! Sue happy society...
 BB> Just because some states have standards lower than NR, does not
 BB> mean that NR is the gold standard.  Maybe the overall baseline,
 BB> but by no means the gold standard.
 JS> NRT is the "gold standard". That is fact, Blake. It satisfies a
 JS> LEGAL test.
 BB> Absolutly not.  It may be fact in your state, but don't presume to
 BB> speak for the entire country.
Go back and re-read the paragraph earlier where I state that it is up to
the individual to maintain his/her "gold standard" or whatever. NR does
speak for the ALL of EMS, in EVERY state. I told you in my last message
about the meetings between the states and the NRT on a monthly basis. I
can't wait for the day a few years from now and say "I told you so!"
I kindly asked you, as an educator, to kindly present those standards
you feel that are above NREMT and the actual EMT license you hold. I am
still waiting for the information to substantiate your claims and
research the material. You just blow it off. I don't think you know
whatcha talkin' about.
 BB> NRT in some states, is a lower level of training/certification, than
 BB> is  acceptable.
Be fair in your comparisons. Loose talk like that doesn't mean much.
NREMT currently *IS* lower than EMT-P, EMT-I, EMT-D, and NREMT-P, but
*NOT* lower than the "average" accepted criteria of EMT in all 50
states. If the NR feels that TN has a good idea on one part of the
standard, and others can benefit from it, it should then be put to the
NR committee, evaluated and voted on. Only then is it included in "the
gold standard" - nationwide. It's people with excellent ideas and
improvements in the way of doing things that make up the "gold
standard". Once the majority of states have adopted and accepted NRT,
then NRT will convert to a federal regulatory body. The NR will always
be seeking input. Your input is just as important as mine.
 JS> *LEGAL* level of care that will stand up in a court of law. It makes
 BB> Again, maybe in your state, but not in others!
Ooops, I'm sorry. I failed to mention that this was a FEDERAL case, not
a STATE case.
 JS> Here's the REAL LEGAL test. If I'm traveling in another state and
 JS> am NREMT certified, and I come upon an accident scene as a first
 JS> responder. An ambulance shows up with two EMT's. As an NREMT, I
 JS> identify myself as such and I take command of the scene. An EMT
 JS> must yield command to an NREMT if the NREMT requests to do so. I
 JS> cannot pass or yield command to the EMT's. I can ask them to
 JS> assist until relieved of command by 1) another NREMT, an EMT-P, 3)
 JS> a NREMT-P, 4) a doctor licensed in that state that accepts FULL
 JS> responsibility for the patient(s) on the scene, or 5) the  hospital
 JS> E/R physician via cellular patch.
And when you propose this scenario to others for input, I expect you to
state it EXACTLY as I have done here. Not put your version of "spin
control" on it like you did in some other messages to get favorable
answers to "your version" of this hypothetical scenario to your buddies
in this echo. If you knew your stuff, you WOULDN'T be asking!! Gotcha.
 BB> In the state of TN, as in  others, you will be requested to leave,
 BB> and if you persist in "taking command of the scene" you will be
 BB> escorted away from the scene by law enforcement.
Oh, I doubt it Blake. You really should open your mind and take a
broader view of all this. Suppose you were on the NR committee and
looking at all 50 states protocols and working with them to find threads
of commonality, and areas needing change. Put yourself in my boots.
BTW, as an EMT first responder, I *usually* yield when QUALIFIED
assistance becomes available. THEY, OTOH, usually ask me to assist once
command is passed. I have never, EVER been escorted away when I
present proper ID. Then we go down to the firehouse for some coffee and
get better acquainted. I've met some pretty fantastic EMS providers,
EMT's who were even better than I. I'm not ashamed to say so. I give
that person a compliment in private. I end up learning a little about
their operations, and they get to hear the leading edge of EMS and
where it's going. We then swap fire T's from departments as souvenirs.
(I keep a supply of Phoenix FF blue T's handy). I get along with
everyone just fine, another requirement for FIRE/EMS, unless it's
someone who thinks they know more than anybody else and refuses to
either prove we're wrong and/or refuses to produce credible evidence.
The most common thing I see is that some depts have EMS totally divided
from Fire Suppression. I suspect Nashville operates that way. Other
communities have them totally integrated. Metroplex Phoenix is
integrated. The cities of Glendale, Peoria, Tempe, Sun City, Sun City
West, El Mirage, Avondale and Mesa run 100% ALS trucks. Two paramedics
(NREMT-P and/or EMT-P) on each truck, ladder, rescue, whatever. The
others on that vehicle are EMT and/or NREMT certified. That is a high
level of service our taxpayers expect from us. Phoenix can't do that
because of budget and a LOT of fire stations (something like 45). They
run 50% ALS and 50% BLS. ALL POLITICAL boundaries have been abolished
except for the Departments of Public Safety/Law Enforcement. The cities
all act as one fire dept. (except Scottsdale). When you have proper ID,
Blake, it makes all the difference in the world.
It seems that in THIS thread, you are doing a lot of huffing and puffing
and I'm feeding you all the facts I know in a very educational way. And
you're on the defense. What are you afraid of Blake? Making a fool of
yourself in a public forum? (You've already done that with your post to
your buddies regarding your distortion of the jurisdiction hypothesis
regarding Medic 31).
Oh, how nice, Blake, you deleted yet another FEDERAL court case I
presented for your viewing to show you how the courts will look at
jurisdictional matters in NR EMS. And therefore sets protocol. So
everyone then modifies protocol (if needed)  to meet the requirements or
legal outcomes of the FEDERAL courts. All matters at state level pertain
to that state only, of course.
Having an NREMT/NREMT-P is equivalent of having a FEDERAL license. If
you don't agree, just wait a few years. It will be by then. Just like
truckers now have a FEDERAL COMMERCIAL DRIVER'S LICENSES. Not a STATE
license or license(s), mind you.
Your portrayal is analogous like saying if you have an aircraft crash
(nobody wants one of those in their area, anywhere!), the FAA, DEA, and
ATF automatically responds with all the local authorities, although
there is no legal arrangement on paper between the feds, city, county
and state jurisdictions, and you're gonna sit here and tell me that the
local cops are going to arrest the FAA, DEA, and ATF for interfering?
ROFLMAO!!!!
 BB> If you try this stunt in Nashville, Metro Police will most likely
 BB> arrest you for interfering.
ROFLMAO!!!! I already have! I have assisted in Nashville 8 years ago on
one horrendous A/A on the interstate on a rainy day. Police can't do
much for medical stuff. I was first on the scene as *FIRST RESPONDER*,
presented my ID to the police, and told them I was taking command for
medical only. They said "OK", but will check out my EMT license. I
told them I didn't mind. They radioed my EMT license for the record and
it was validated from Phoenix within a minute. The cops were relieved
that I was there already. The Good Samaritan Law is now in effect,
protecting me out of my jurisdiction. I informed them of that. They
understood what I was talking about.
When the apparatus responded about 7 minutes(!) later, the police showed
the chief my ID, I already had triage somewhat sorted out, I told them
my triage and quick assessment of 9 victims, and I walked up to the
chief said, to him, "I would be glad to assist, but would you assume
medical command from me please?" The chief then said to me, "Will do,
Thank You. Command passed" and radioed that "command was then assumed by
the chief." It then was officially on tape. He then aked me if I really
wanted stay and assist since I was from out of state. I said that I'd
like to because I could possibly learn a few things along the way. He
smiled and told his crews that I'd be assisting. And I went back to work
assisting the EMT-P's. The guys were surprised that I had stopped and
did what I did. They expressed their gratitude. Arrest?? hahahaha....
Never happened, EVER. ANYWHERE in my 12 years as EMT!!! In any state!!
Perhaps you can answer this question for me. Why were YOUR state
certified EMT's asking ME "why are you wearing latex exam gloves?" back
then in 1988? I then explained to them the OSHA requirements and
Bloodborne Pathogens problem (body fluids). That problem was just a
seed/nutshell then. Phoenix, Seattle, and LA were already using gloves
since 1982. Paramedics at first, then it was mandated for all EMS
providers. LA, Seattle, and Phoenix have large gay communities. And we
have extremely large populations of geriatric patients due to our nice
winter weather.
For four years, I was a B.C.'s assistant in the command van. I know all
about command protocol. It doesn't vary too much in places. The only
thing that varies is the size and numbers of alarms for situations.
Metroplex Phoenix, Seattle, and L.A. city/county are considered the
LEADERS in EMS. Many cities send personnel here to Phoenix or LA for
a week to learn how everybody gets along without any political squabbles
and the tight integration between the cities as EMS providers and the
base hospital arrangements.
If I have a fire at my house (Glendale), I will get a first alarm
assignment, not a 2/1. To wit: Phoenix engine 33, Phoenix Ladder 33,
Glendale Engines 153 and 154, Peoria Engine 191, Peoria Ladder 191,
Battalion 9, and Glendale Rescue 153. Those are the closest units.
And they're there at my house in 2 minutes flat. Peoria shows up and
assumes command first because I'm 1/2 mile from the Glendale/Peoria
border, they retain command until end of task, even with Glendale units
present. Talk about what cooperation and aherance to the "gold standard"
in fire suppression does! The reason they send so much is that they are
extremely agressive with fire control in this tinderbox dry environment.
What's Nashville's criteria from alarm incoming to onscene criteria?
Everybody valleywide must have less than 3 minutes response time from
end of 911 call to onscene.
All of the metroplex go through Phoenix Fire Academy except Scottsdale
(they have RURAL METRO). We ALL have the same rules and protocols.
Station 33 is 6 miles away due east, Station 191 is 3 miles away due
west, station 154 is 3 miles away due east, station 153 is 2 miles away
due north. Station 152 is 6 miles south if station 33 is busy. Station
155 is 6 miles north if 153 is busy. They plan each station on the metro
grid to have a radius of coverage of 3-4 miles in diameter depending
upon housing density. Now that's cooperation. Station 154 is right on
the Phoenix/Glendale city boundary. It serves both cities. Bet you won't
find that kind of interdepartmental comraderie in Nashville and it's
suburbs. How about HAZMAT? We have 4 valley Hazmat Teams - Phoenix,
Tempe, Glendale, and Mesa. When a HAZMAT alarm is called, all the HAZMAT
apparatus from those stations will respond anywhere in the valley.
Again, same "gold standard", same S.O.P.s. No problem.
Dispatch is downtown on 10th floor Public Safety Building. It is the 911
nerve center of the whole valley. It is glass windows on all 4 sides. We
can see everything in a 360 degree radius. We even spot fires first from
dispatch before the call ever comes in. The triplexed (for fault
tolerance) computer system uses the GPS system and all vehicles have
MDT's. So we are able to put nearby station(s) on 'alert' status - all
gear on and waiting in the trucks for the confirmation/destination on
the MDT.
We base our system off the huge LA city/county system. It's been a
tremendous success. I remember when I joined and before we threw
away political boundaries. Cities would fight about calls because it was
on a boundary, and although the accident happened in one jurisdiction,
it wound up in the other. No more. I'll also have you know that
Arizona's state EMT was more stringent than California's standards at
one time. We've closed that gap now. We now have INTERSTATE operating
agreements with California, Utah, New Mexico, and Texas on our borders.
They have the SAME protocol and standards. It's great to work with a
company from out of state or out of the county and you know what
S.O.P.'s already. Question for you. Why was the Phoenix Metroplex Fire
Dept Special Task Force Crew (all NREMT-P at that) one of the first out
of state units requested by Oklahoma at the time of the Oklahoma City
bombing last year?
We're not noted for our "status quo" position. We are on the leading
edge of medical technology. As an EMT, can YOU do IV's and cardiac
defib? Probably not. By next year the new "gold standards" will be
coming down from NR. You WILL be able to do that once you get
trained and recertify/pass NREMT. In essence they are combining
EMT/EMT-I/EMT-D (where factions exist) into NREMT. NREMT-P is going to
get a lot more complex. Paramedics will be able to do certain procedures
that are normally performed in the E/R, like administering clot busting
pharmacology on CVA's using new extremely high tech cardiac monitoring
devices, and other procedures where the first three minutes spell the
difference between life and death and there is no time for patient
stabilization and transport. That means the EMT (now NREMT) must assume
some of the paramedic's functions. Paramedics will receive training that
is almost up to the point where they can function as physician
assistants specializing in emergency medicine. Gee, then NREMT will
DEFINITELY be a higher standard then your already higher EMT standard.
I've definitely proved beyond a shadow of a doubt everything I've told
you and my depth of knowledge on all fronts. You haven't. Your responses
to me indicate that you're probably a relative newcomer to the fire/EMS
services, and that Nashville operates fire suppression as a different
division than EMS. You talk about "Medic Units". That's a tip off.
You sound like a cocky firefighter who knows nothing about EMS. Or a
cocky EMT who knows nothing of firefighting. Otherwise you wouldn't have
taken my hypothetical case and ask the other EMTs regarding it's
jurisdictional validity with your version of "spin control".
Oh, BTW, I also teach. Do you? Teaching is more rewarding than many
other jobs I could hold that pay more. I definitely have a problem
maintaining class size. Seems that everyone wants to get in on my
classes as I'm very popular as an educator. I stay on top and it thrills
students when I give them information they would never find in a
textbook. I litter my lectures with actual EMS cases with the names
changed to help them remember concepts. Way back, in 1985, I was honored
in my first year by the Fire Department with a distinguished firefighter
/ service award. My FIRST year as a rookie. I even took the Dale
Carnegie course in 1990 and was voted by my peers to receive the
prestigious Personal Progress Award, and the only - Highest Award for
Achievement. I have BSEE/BSCS/BAFS, and MSCS degrees, and thinking about
getting my Ph.D., after helping 2 other people obtain theirs. (I should
have gotten an honorary Ph.D. for all the work I put into the two ).
I've also been the one of the people responsible for recertifications of
ALL of Arizona's EMT's, EMT-I, and EMT-P's from 1985 to 1995 even though
I only hold an EMT license. Now that the state's going totally NR, it's
a relief.  I'll tell you a fact that will stun you. I am hearing
impaired. It's been a blessing, not a disability.
Just a reminder about your "higher standard" EMT than NREMT. It's time
to put up or shut up. I'll wait for your information to see if you know
what you're talking about or blowing smoke. You ruined your reputation
by posting the other messages you did. I welcome your input for the NR
committee. Provide it or shut up.
John FF/EMT
PS. Providing it will build your credibility, ignoring it will only
reinforce what I said. I also moderate bbs conferences. I know what I'm
doing and I know what you're doing. So much for that.
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