Two Tactical Flashlights, A Shemagh And A Third Grade Project

Two tactical flashlights, a shemagh and a third grade project, all under a sky showing an absurd dance between a sliver of a crescent moon, Venus and Mars.


Sounds like a prelude to some terroristic, apocalyptic event does it not?

Nothing could be further from the truth. Normally I keep abreast of interesting things and the schedule by which the show up in the sky. This was not the case tonight. I have been a bit busy and was not really aware that Venus was going to be shining brightly above a thin crescent moon with a smaller Mars off to the side. I noticed this event in the sky on my way to pick up the twins just after dark.

Rhiannon had reminded me this morning that they had to be taken to the riverfront to do crayon rubbings of the state seals for their assigned states regarding a third grade project. This started a week ago when we had to look up state nick names about a week ago. Those nicknames were the first things on a page long list of stuff they needed to learn about a state.

She had Tennessee. Peter had North Carolina. Both of them were engaged. The twins are two of my kids that take homework very seriously and glow when they know they have completed a homework assignment in an exceptional fashion. One of the last things on this list was the rubbings.

You see, we have a great resource for this in Evansville... the Four Freedoms Monument. It sits on our riverfront downtown and is comprised of an elevated areas with four columns representing our American freedoms that are surrounded by concrete monoliths representing the states in order of admission. Each of these contains a large metal state seal in relief. There is even a time capsule to be opened in 2176.

We bundled up to brave the cold wind coming off the Ohio River, grabbed the flashlights and headed downtown. You have to park about a block away and walk to the small plaza containing the monument. The river runs on one side and the buildings of downtown are visible on the other. Peter used a flashlight as we walked through the grass. Rhiannon had the rolled up commensurate two pieces of large paper and the crayon.

Of course, North Carolina was nestled amongst the 13 isolated monoliths representing the original states. Peter quickly, but meticulously made his rubbing, being careful not to break the only crayon we had brought with us.

We then moved to Tennessee and Rhiannon completed her homework by rubbing the crayon over the waxy paper laid atop the seal.

We spent a bit discussing the order the

states were admitted and then the four columns and the freedoms carved into each of these tall icons. We discussed the importance of those freedoms, dwelling a bit longer on the freedom of religion and the freedom of speech.

The occasional moment was taken to note the celestial beauty of the moon and accompanying planets in their odd dance of this evening. The twins are adept at noticing the planets and pointing out the

difference in how they appear from stars when viewed from Earth.

I walked a bit ahead in the dark when it was time to head back to the car. I heard them talking about finishing this week-long assignment on their designated states. It was obvious that had enjoyed it and had learned quite a few things.

On the way home we discussed the times we have been in those two states and the

fun we had there. Again, these two enjoy their homework so it is easy to insert extra facts and draw correlations.

I enjoy times like these. Especially those where you enable them to learn on their own and make connections. I also love having two kids who enjoy our local riverfront. They learn about our country, our world, the night sky and our Lord Jesus Christ.

Our school is a great gift that has the ability to teach in all areas of life, including that which is most important... our faith.

Hearing them sing together the songs that they learn is always a joy and reminds me that we have them in the right place at the right time:

Praise to the Father, and to the Son, And to the Spirit; God Three-in-One. With all the saints and angels we bring Glory and honor as we now sing.

Upon the Rock of Salvation we stand; Jesus will bring us to His Father’s land! Faithfully rest on Jesus, God’s Son, Who, for the world, salvation has won!

Homework, nighttime adventures by flashlight and singing songs from memory.

I am but the driver... the transportation. Parenting is all about getting them there.

The shemagh? Well... it's to keep my neck warm. I'm getting older you know.

A few more pictures from this evening below...

Taken by David Hampton near Holland, IN

Taken by Melissa Hall

Four Freedoms, the Moon and Venus (Mars
is to faint to see)

 

 

 

 

 

 

 

 

 

A Note On The Scope Of Practice Change For The Indiana Advanced EMT

January 20, 2017

Those of us on the Indiana EMS Commission made a decision today that affects the scope of practice for Indiana Advanced EMTs.

Anyone who was involved in Indiana EMS just a few years ago will remember the transition from having two mid-level certifications (Emergency Medical Technician - Basic Advanced and Emergency Medical Technician - Intermediate) to a single mid-level prehospital caregiver, the Advanced EMT. This occurred chiefly due to the transition from the old DOT curricula to the new national EMS educational standards (NES), but there were also many discussions (and arguments) regarding appropriate length of programs, needed clinical hours and contacts and if there was any connection of these certification levels to improved outcomes.

It was a long year of debating and trying to do the right thing for the people in the communities here in Indiana. The end result, the new Advanced EMT was still given some additional abilities above what the NES curricula allowed at the national level. One of those additional skills was a continuation of several components of ECG interpretation (not all) and manual defibrillation (rather than the use of an automated external defibrillator).

The Advanced EMT exam for Indiana was destined for National Registry due to the unparalleled work that goes into their exams, however that exam did not cover Indiana's desired ECG component. A separate test was developed and was administered and available at several sites throughout the state. Pass rates on the Registry exam were one thing, but the pass rate on the separate ECG test has been less than favorable.

Why?

It could be many things... variances in the interpretation of the curricula... variances in instructors and what was delivered... some have even been taught things that were not in the ECG curricula in the first place.

In all, there are about 500 of this certification level certified in Indiana today. In the last year there have only been a little over 70 added to make up that 500. Many are reporting that they cannot pass the additional test.

As a Commission, we were faced with the fact that we had a curricula that had been applied inconsistently in some cases, a test that was extremely hard to pass, and the ever present elephant in the room... the fact that since cardiac medications were removed from this level by the NES that cardiac monitoring with ECG interpretation and accompanying manual defibrillation really have no patient outcome impact.

An automated external defibrillator will perform the only proven outcome driven intervention as easily as a regular monitor with manual defibrillation capability.

So... in the course of discussing options, the following was decided:

• ECG Interpretation and Manual Defibrillation will no longer be taught in the Indiana Advanced EMT course.
• Those individuals who have already successfully passed the Indiana Cardiology Test (ECG), in addition to the Advanced EMT exam (NR), will be allowed to continue to monitor ECG rhythms within the curricula and provide manual defibrillation until 12/31/2017. After that date ECG Monitoring and Manual Defibrillation will no longer be allowed at that level.
• The Indiana Cardiology Test (ECG) is abolished.
• This does not affect existing rules regarding the acquisition AND transmission of 12-lead ECGs.

These changes only affect the Advanced EMT level practitioners. This change moves us closer to the NES which allows for a national test to be used to determine certification competency.

Most of all, this acknowledges the practice of evidence-based medicine.

This decision may not be a popular one and was reached only after lively discussion mainly centered around affecting patient outcomes. The Commission's purpose is to create systems of care for Indiana. There is an ethical obligation to assure that this is done with quality and the end result in mind... patient lives.

There will be more information released on this topic soon.

EMS Commission meetings and decisions often center around change. We are currently looking at CEU requirements due to changes at the national level that could offer some applicable education offerings and consistency with Registry.

We also noted today that there is a large number of quality educational offerings occurring in the state during 2017.

Change is often hard. Understand that the changes the Commission makes are those that we feel will support outcomes.

As for myself as the Chairman, I wanted to get a public explanation out as soon as possible as was done with the National Registry decision last year.

Communication of the thought process behind decisions is crucial to understanding. If you are correctly informed, you have the facts. I would encourage those who are affected by this decision to understand that this does not lessen your abilities to provide positive outcomes. It just further defines a skill set so that what you do perform is known to have impact when combined with the overall Advanced EMT skillset.

The Indiana EMS Commission and the citizens of this state appreciate the efforts of every caregiver... EMR... EMT... Advanced EMT... and Paramedic.

One of my favorite quotes was said a few years back at a national EMS conference: "EMS must stop defining itself by the skills it performs and start defining itself by the outcomes it provides."

This is the future we owe our patients. Skills do not define us. Lives saved do.