Paramedic, in a nutshell

So it's taken me this long to get it straight in my own head, and read through all the documentation associated with our courses.  Ten months of courses, followed by clinical/field.

                                                                                                UNIVERSITY

                                                                        CLASS           CREDIT

COURSE                                                       HOURS          HOURS

A&P for Paramedic Practice                           64                    3

Introduction to Advanced Practice                64                    3

Emergency Pharmacology                              40                    2

Patient Assessment & Airway Mgmt             64                    3

Cardiology                                                      112                  4

EMS Operations                                             64                    3

Trauma Management                                      64                    3

Medical Emergencies                                      66                    3

Special Populations                                         64                    3

2243 Assessment Based Management            48                    2

Clinical – I                                                      250                  2

Clinical -II (Field Internship)                          250                  2

1150                33

 

The A&P class is taken "on the side" throughout the rest of the courses.  Ideally, we should use it should follow along with what we are doing in regular class.  Meaning that we should be ahead on the A&P reading (I am as yet, not ahead in this reading).  Speaking with one of the advisors, he said that in the past some people have left it for last.  We cannot start clinicals until it's done, so they seriously crammed at the last minute.  I get tachycardic just thinking about that (and getting through the rest of class will be much easier if A&P is done).

With classes on Tuesday and Thursday, I really cannot think about doing any “extra” reading between Monday and Thursday, so I guess A&P will live on the weekends.  I’m attempting to be a better student – actually setting up a schedule for studying – but that’s a constant struggle for me with my ADD/procrastination learning style.  I usually end up reading and doing quizzes on my breaks at work.

So, what does “Introduction to Advanced Practice” entail?  So glad you asked.  My life looks like this:

Class                Topic(s)

1                      Orientation and Course Overview

2                      Being a Paramedic

3                      Illness and Injury Prevention

4                      Legal Issues and Ethics

5                      Life Span Development

6                      Pathophysiology 1 (Cells and Tissues, Role of Electrolytes, Acid-Base Balance)

7                      Pathophysiology 2 (Genetics, Hypoperfusion, Types of Shock)

8                      Pathophysiology 3 (Immune System, Inflammation, Stress and Disease)

That’s a ton of work.  And about 300 dense pages of reading.  In four weeks.

I can totally do this.

Phase 3 Clinical Trial - Mag Sulfate for stroke

http://www.fastmag.info/index.htm

This is the cool stuff I get to hear about in paramedic class.  We have people all over the country (and a few outside) in our course, so they are practicing in very different environments.

Might be the next thing in stroke care.

Overview
        The FAST-MAG Phase 3 trial is a multicenter, randomized, placebo-controlled, double-blind, parallel group trial of intravenous magnesium sulfate initiated by paramedics in the field within 2 hours of symptom onset in 1700 patients with acute stroke. The primary objective of the study is to evaluate the efficacy and safety of field-initiated magnesium sulfate in improving the long-term functional outcome of patients with acute stroke. Patients with acute stroke will be identified in the field by licensed paramedics who have received training in basic and advanced cardiac life support, stroke recognition, and specific procedures relevant to the proposed study. Physician-investigators will approve each patient for study entry after cellular phone contact with paramedics. Physician-investigators will also by phone elicit explicit informed consent to participate in the study, from patients when the subject is competent and from on scene legally authorized persons when the subject is not competent.
         Paramedics will initiate a loading dose of 4 grams magnesium sulfate iv over 15 minutes or matched placebo, followed after hospital arrival by a maintenance infusion of 16 grams magnesium sulfate iv over 24 hours or matched placebo. Follow-up assessments will be performed at ED arrival, 24 hours, 48 hours, day 4, day 30, and day 90. The sites involved in the study will be EMS system rescue ambulances and receiving hospitals in Los Angeles and Orange Counties, California. The Clinical Coordinating Center and the Neuroimaging Analysis Center will be at UCLA Medical Center and the Data Management Center will be coordinated through Stanford University.

Study Hypotheses
The central aim of this study is to demonstrate that paramedic initiation of the neuroprotective agent magnesium sulfate in the field is an efficacious and safe treatment for acute stroke. The study design is a multicenter, randomized, double-blind, phase 3 clinical trial, using intention to treat analysis, of magnesium sulfate versus placebo among ambulance-transported patients with acute stroke, with study agent initiated in all individuals within two hours of stroke onset. Successful conduct of the trial will serve as a pivotal test of the promising neuroprotective agent magnesium sulfate in acute stroke, and will also demonstrate for the first time that field enrollment and treatment of acute stroke patients is a practical and feasible strategy for phase 3 stroke trials, permitting enrollment of greater numbers of patients in hyperacute time windows.

Primary Hypothesis:
Treatment with magnesium sulfate improves the long-term functional outcome of hyperacute stroke patients.
The primary study endpoint analyzed to test this hypothesis will be the difference in distribution of scores between magnesium sulfate and placebo groups on the modified Rankin Scale measure of global handicap, assessed 3 months poststroke.

Secondary Hypotheses:
Treatment with magnesium sulfate improves the long-term outcome of hyperacute stroke patients on measures of activities of daily living, neurologic deficit, quality of life, and mortality.
The secondary study endpoints analyzed to test these hypotheses will be the difference in distribution of scores between magnesium sulfate and placebo groups on the Barthel Activities of Daily Living Scale, the National Institute of Health Stroke Scale (neurologic deficit), the Stroke Impact Scale (stroke-specific quality of life), and in mortality, assessed 3 months poststroke.

Treatment with magnesium sulfate improves the long-term functional outcome of each of the following subgroups of hyperacute stroke patients:
Patients with ischemic stroke
Patients with intracerebral hemorrhage
Patients with ischemic stroke treated with conventional intravenous tissue plasminogen activator
Patients with ischemic stroke not treated with conventional intravenous tissue plasminogen activator
Patients with ischemic stroke treated within 60 minutes of onset
Patients with ischemic stroke treated within 61-120 minutes of onset
To test these hypotheses, the primary study endpoint, differences in the distribution of scores between magnesium sulfate and placebo groups on the modified Rankin Scale measure of global handicap, will be separately analyzed in each of these subgroups.

What have I gone and done? (or Paramedic class 1)

I'm a fairly busy person.  Work close to full time.  Master's degree seeking. Volunteer for EMS in local town.  Volunteer for gov. doing EMS administrative stuff.  EMT on call.

So why not add paramedic school to the mix?

I found a hybrid class - online "live" classes with a skills component where I will be flying to Massachusetts for skills training next year.

We had our first class on Thursday and I had my first (of what will likely be many) OMG-what-have-I-done? moments.

Well, maybe not my first.  The first came when I signed the loan papers for the class.  I will be paying this one off for 3 years.

Couldn't find a microphone with a mute button.  Running around like a headless chicken for 30 minutes on that one.  Got logged into the class web site.  Over 40 people signed in.  It's hard to tell the actual number since several people were logged in multiple times.  

40, though.  That's a lot of students.

I thought back to some other courses I've heard about - 50% or more don't finish.  Yikes.  I have to make it.  I cannot fail this.

Some people were overly chatty - there's microphones, sure, but also a chat pane.  This isn't twitter for chrissake!  Some people would just not shut up.  Having conversations while our instructor was talking, blah, blah, blah.  

We went through the basics - introductions of the instructors, what is expected, how to access the online quizzes, assignments, and tests.  The only pure moment of silence came when someone asked how much time outside of class would be needed to study.  Brad (owner/instructor) pondered this for a minute and said, "probably 15 hours."  SILENCE.  It's about what I figured, but most people probably have been out of student mode so long they really didn't put much thought into it.  Yep, folks.  2+ hours for every class hour.

I had forgotten the beginning of EMT class - it's all about EMS operations, ethics, and legal issues.  Paramedic is no different.  Not the most exciting stuff, but worthwhile.  I've got to get back at it!

Here I go...

one day down south

So I'm visiting my relatives in the southwestern US, enjoying the sun and 90+ degree heat while we get a sifting of snow back home.  It's been a long time since I've been on what could be termed a vacation.  Most of my vacations consist of driving to a relative's house to get some sort of work done.  This one was really no exception.

Grandpa is not doing well.  Dad needed help driving a truck and trailer south.  Vacation it is.

Three days on the road with pops.  Got to visit with my grandpa for a bit.  Unloading the truck and trailer.  Opening the house for the winter.

Today is my day.  I have done nothing but sleep in, eat, play in the pool, play on the computer.

Back to work and reality tomorrow -- a ridiculously hectic week assisting with a conference.  It will be 16+ hour days and little sleep.  Paramedic school starts on Thursday.

But today is mine.