1. What do you want to specialize in? Power, Analog, RF, Digital, electromagnetics, signal processing, control systems, etc? Each branch has a couple of good books. I like Microwave Engineering by Pozar.

  2. It’s a great book to be sure…but also wildly inappropriate for an incoming first year undergraduate haha

  3. Should I fly to Baltimore instead? Does MARC go there, would it be easier.

  4. There is a MARC station at BWI but it’s on a completely different line. You’d have to take one train from BWI all the way to Union Station, then switch to another train to go to Martinsburg

  5. Plan is to turn it into sidings for Met/H&C/Circle line trains, I believe they’ll be able to store 10-12 S stock trains in there. Not quite sure about timing (last I heard it was put on hold due to the pandemic) but as far as infrastructure, really just need to reconnect it to the Underground tracks here and electrify it through to the disused platforms at Moorgate

  6. Just to add to this, HEMS have pioneered pre Hospital care in an Emergency life or limb situation. They’re capable of using what’s called Rapid Sequence Induction to put the patient under a General Anesthetic on scene, allowing the patient to be treated more robustly at the scene and be given life saving interventions rathering than just ‘scoop and go’. They’ll take the patient to the appropriate Hospital for their needs - Major Trauma, Cardiac Unit etc not just the nearest.

  7. Have to say, as an American it’s a little funny seeing RSI as an example of pioneering prehospital care when all of our HEMS and many of our ground ambulances have been doing that for years. (Now whether they should be doing it is another story entirely…haha). I’ll never forget seeing them do a thoracotomy and a REBOA on TV and thinking “holy shit, this is what prehospital trauma care could be”. Couldn’t think of a more deserving charity for my money, that’s for sure

  8. My thoughts are with the poor person who died today. Out of interest though by the time they’d have got from Shaftesbury avenue to Trafalgar Square and onto the helicopter they could have got to at Thomas’s which is only a few mins away, or is it that they have a doctor on board the help that was needed?

  9. Arguably the main purpose of the London Air Ambulance is to literally bring the hospital to the patient. The helicopter is the fastest way to bring the doctor and equipment to the scene and while they have the capability to transport the patient in the aircraft, my understanding is that often they’ll do what they need to do to stabilize the patient on scene and then will transport via ambulance to the major trauma centre. (There are of course many factors at play in the decision to convey by road or air and there’s not a black/white rule book to follow for all situations). Contrast that with many of the other air ambulances around the country/world which (though they can also provide similar services in most cases) are also used because transport time by ground ambulance is so long

  10. I suppose I’m just wondering what the benefit of this is compared to asking them (paraphrasing a bit here) “what were you born as and what do you currently identify as?” Both answers are important

  11. Great North Air Ambulance in northern England

  12. You should be able to take the class and sit for the NREMT. You probably can get a state license, but may have to submit additional documentation; best bet is to contact your state’s EMS office for more details. You will not be able to actually work as an EMT unless you have the right work authorization (i.e. citizenship, green card/permanent residency, or a work visa)

  13. I mean, OP asked about apples and oranges. It’s generally true that LPNs make more than EMTs but less than paramedics. That’s not really an apples and oranges thing, that’s just comparing average hourly wages. It’s harder to answer “what they can do” because they are two different fields as you point out, but the most direct comparison is the ED in hospitals that actually use paramedics as more than IV monkeys. In which case they generally operate somewhere between an LPN and an RN in terms of scope/ability, with the EMTs down well below the LPNs

  14. No, it isn’t generally true that LPN’s make more than paramedics. It’s actually fairly rare.

  15. That’s…what I said? There will always be exceptions and regional differences, but the fairest comparison is the federal pay scale where LPNs are typically GS-6 positions and paramedics between GS-7 and GS-9

  16. My understanding is that it’s what has been written already, with the possible but not definitive caveat that if you begin care in the field when not required to, you cannot stop care and hand off to a provider below your level, perhaps barring super minor cases. But perhaps a medic might want to chime in here.

  17. Generally not true unless you are actually practicing at your full scope while off duty, which is rare (and usually illegal)

  18. I applaud the initiative, but honestly 5-10 years is a fairly long time in US HEMS these days — bases will close, new bases will open, companies will merge/be bought out, aircraft will be replaced, schedules and pay will change. All that will really be guaranteed is you’ll need at least 3-5 years of experience, you’ll be doing some mix of scene and IFT calls, and you’ll most likely be partnered with an RN. Beyond that, just focus on getting solid ground experience, consider some (legit) ground CCT experience, and then when you move and get closer to applying, you can network and research specific companies

  19. It's always weird to see these types of threads because I had a pretty extensive OB curriculum. I was under the belief that was standardized per the NREMT.

  20. I wouldn’t say the NREMT standard is that extensive though. My program was fairly in depth (for paramedic school) but over the years as I’ve gotten more experience and taken more classes, it’s pretty remarkable what more there is to know

  21. Yeah you make a great point, paramedic school really needs more in that area. IMO every medic should also take the

  22. I have to say I was extremely disappointed with the blended learning format in the new 8th edition. I took the advanced course, but hardly any of the advanced topics were actually covered in the course itself (though they were all on the test, which was so fun). The book is a good resource but the course was much better when it was done in person

  23. Hey, thanks for the in-depth reply! There's surprisingly not a ton of info I was able to find about some of those more specific aspects, so your insight is very helpful!

  24. There’s a few others. Delaware State Police has basically the same kind of program. Virginia State Police has medevac aircraft but some (all?) of them use non-LE clinical staff from local FDs and hospitals. Reasonably common on the west coast but at the county level — lots of large sheriff’s offices have medevac helicopters. And more locally, both Fairfax County PD and US Park Police have medevac helicopters, the latter flies into PG/Southern Maryland pretty often.

  25. AFAIK you need to be LE to become a VSP flight medic. I've heard that many of these places are garbage in the medical sense since that you only needed to be a medic for a year and you go from 0 to medic

  26. It might depend on the base. I know that the base in Chesterfield uses Chesterfield County FD for their medics and possibly VCU nurses as well

  27. Finish nursing school, go do 3-5 years of ED and ICU, then go work as a flight nurse or CCT nurse

  28. A ton of people in EMS are on meds for some sort of mental health condition…and those of us that aren’t probably should be lol. The only reason I could see you being rejected is if one or more of your meds would prevent you from safely driving or operating heavy machinery (e.g. Xanax), and even then only if it’s a med you’d need to take regularly.

  29. If you’re not affiliated with an EMS agency, you’ll recert as inactive since there’s no one (as far as NREMT is concerned) who can verify your skills. This really isn’t a big deal, you’ll still get a piece of paper that says you’re NREMT certified and should you end up working for an EMS agency in the future, it’s literally just a form you have them sign to get you back to active status.

  30. You can use your NREMT cert to apply for reciprocity to get licensed in NJ. It’s some paperwork and then you have to take a refresher course

  31. Gone but service is still fucked

  32. So bad news first: you’re almost certainly not going to be able to complete the skills verification, at least without lying about it. Assuming you’re not still employed/affiliated with an EMS agency back home, you’d have to find someone in CA who is qualified to sign you off on skills and willing to watch you do it remotely with equipment you somehow managed to get hold of abroad. The chances of that happening are slim to none; realistically, you need to do that part in person.

  33. I figured that would be the case. I didn’t realize I could do all 40 hours without a live instructor, the information I saw said only 24 hours can be distributive education and the rest would need a live instructor. Maybe what I’m reading isn’t the updated information. Thanks for the help!

  34. Yep, NREMT changed that temporarily in 2020 for the pandemic and then made it permanent within the last year or so

  35. Wildly depends. There are places like NJ where they’ll do a tiered response on 911 calls (city BLS truck with hospital ALS). There are places like NYC where a combination of public, private, and hospital units all handle 911 calls depending on the location. There are places where the hospital EMS crew primarily does transport but will back up the city EMS crews if they’re all out on calls. There are places where the hospital EMS crew only does transports and no 911 calls. And places with other arrangements I haven’t mentioned

  36. I assume it’s because CRASH-3 only studied it in patients with GCS < 13 or confirmed intracranial hemorrhage. Since we can’t confirm the latter in the field, the only evidence-based practice we have is the former group. In other words, we don’t technically know benefit or harm of giving it to patients with GCS > 12 and unconfirmed intracranial hemorrhage since it hasn’t been studied

  37. Would love to hear your guys thoughts. OP states that he diagnosed the patient with septic shock, treated with IV fluids and medications (unsure which ones) and made the decision on whether or not to divert the flight.

  38. There’s definitely a bit of TMFMS in there, but on the whole I believe it. Definitely reasonable in my opinion. FAA requires 500mL of saline and IV supplies, among other basic drugs, and airlines are free to add to that as they see fit. Zofran (or other IV antiemetic of your choice) is common, and an airline like Hawaiian that flies over the ocean would likely have additional IV fluid and other supplies to sustain them for the longer time it’ll take to divert. And while yes, technically it’s the captain who makes the final decision on whether or not to divert, they’re going to ask “do we need to land now or can we continue?” and make the “decision” based on what the clinician (onboard and/or via radio on the ground) says

  39. Interesting. It bothers me that they diagnosed this patient with septic shock, and that "they" made the decision to forgo definitive care on the ground. 2L of fluids over 5 hours with antiemetics may show positive change in the patients presentation, but it won't fix their problem

  40. I never understood why they didn’t build a station for concourse D. Surely any replacement terminal that gets built would be long enough that it could reach from the C station to where a D station would be.

  41. Money, would’ve cost around $200 million (in 20010) to extend it to D. I genuinely wouldn’t be surprised if we get Concourse E before a new Concourse D + AeroTrain extension, since there’s already a station there

  42. No set respiratory rate, it’s all about if they’re breathing effectively and adequately. If not, bag for a minute or two and then give a little bit of Narcan

  43. wait wait wait, I find this hard to believe, I had a huge ketamine addiction in college and that drug you can do a whole shit load of quite safely, you pretty much become unable to after a short time. I find it hard to believe they had 5g of ketamine to inject him in an ambulance. But maybe, who the fuck would administer so much? There has to be some other circumstances or something else at play here. Reading more into it, it seems he had an issue straight away, IMing takes a while to induce, I also find it hard to believe they found a vein on a struggling victim in that amount of time. I mean its all fucked but I just hate when chemicals get blamed when its most likely some other mitigating circumstances. Like how did he DIE, you die from overdoses generally from other things lack of respiratory function/choking on vomit etc.. He said he couldnt breath. Honestly I feel like maybe we should use tranqs in a responsible way to de escalate situations sure beats a bullet.

  44. 500mg IM, if I remember correctly. It’s high for someone of his size but not completely unthinkable either. Like any sedative, ketamine can cause adverse effects that can definitely be lethal if not noticed and treated, such as respiratory depression, vomiting/aspiration, laryngospasm, etc. I’ve seen these happen on bigger people with lower doses of ketamine, I’ve seen smaller people have no problems on higher doses. There’s not a 100% reliable way to predict who will have these side effects and who won’t, so what you need to do is assume they will and prepare for it — monitor them closely (we’ll have someone whose sole task is monitoring the patient’s airway/breathing) and have equipment/meds on standby to treat if needed. This crew did basically none of that

  45. Wilderness First Responder (WFR) is lower than EMT but certainly more than basic first aid. There’s not a “standard” WFR course, but typically they’ll be 7-10 days. NOLS is a popular one from what I’ve heard.

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