If you have been reading the A-Z Series you know that I have been trying to avoid too much clinical type articles and have been focusing more on general ideas on what we face each day as EMS professionals and also why the basics of what we learn in the beginning of our careers applies to what we do every day.

When I mention RSI or Rapid Sequence Intubation I don’t want to get into the clinical aspect of it on why Succinylcholine over Vecuronium or on Mallampati classes. There is a wealth of clinical information on this on sites like EMS1.com and JEMS.com to name a few.

What I would like to mention is that RSI is becoming more of a standard in many EMS agencies and most have a specific training requirement of their paramedics to be able to perform this skill in the field. RSI encompasses many dangers and difficulties for the provider and it truly brings us as EMS professionals to the next level of care and skill level.

When many are suggesting that endotracheal intubation in the pre hospital setting should be a thing of the past. The fact that RSI is such a hot topic, I think strengthens our need for advanced airway management in the field. The key is having the proper training not only for the skill itself, but also understanding the medications and their properties. That is where the danger lies and some providers may take this danger too lightly. Which of course can only bring us back to the thought process of sending ETI to the bench.

We as providers must take ETI and in turn RSI seriously. That means getting the proper training, seeking out clinical opportunities to perform the task and most of all knowing when it just isn’t possible and not letting our ego get in the way of what is best for the patient.

While I do see the advantages to non visual airway management. There will always be a place for true advanced airway techniques. After all “airway” is first on the list. Without being able to secure and maintain it - everything else is just spinning our wheels.

I don’t pretend to have all the answers or know it all when it comes to this subject. You can talk to ten people and get ten different views. The one view though I think we can all agree upon is that education, training and practice will allow us to continue providing true pre hospital care that includes everything the ABC’s encompass. Instead of focusing on just the pre hospital transport part.

Along the lines of all this training and advances in how we provide care. You must be ready to do so. When I say ready or not, I mean just that. You are either ready or you are not ready. So, ready for what? Well, think about that for a moment. Ready can relate to checking your ambulance to make sure it not only runs and has the lights working, but also that you have all your equipment and that it works as well. From your laryngyscope light bulb turning on to having enough non rebreather oxygen masks.

It can also apply to being ready as a professional and knowing your local protocols, procedures and how to apply them. Being ready to read the 12 lead ECG, start the IV or just plain lift the patient.

I think you get the idea I am going for here. Be the EMS professional that is ready. Ready in training, equipment, knowledge and attitude. The patients may not say it, but ready or not here they come.

A few years ago, I attended an adult education school. It was great. I had tried a community college program before and thought I like it, until I tried this center. The classes at the adult school were concise and didn’t contain any filler classes.

I feel like I have wasted those three years at the community college. Some of the classes were not necessary and wasted my time. There were breaks in between classes that were sometimes three hours long.

The community college was not very flexible with beginning dates as well. There was either September or January. They only offered specific classes in each semester. I had no choice at to when I could attend class. I kind of felt like this school was in control of my life for three years.

Some days, we would begin early, and some days not till noon. Other days, we would work late or finish early. Keeping a part time job and going to school was stressful and confusing. It was difficult to keep classes, exams, assignments, and work hours all in order.

After not landing a job in my sector, I decided to go back to school. This time I was smarter. I decided to go to an adult education center for the main fact that it was only 8 months long and came out with a diploma and the community college version was two years.

This school was amazing. Classes began at 8 and ended at 1 everyday. We had 15 minutes breaks during the classes in which we were able to leave and come back. The programs were structured and organized.

The way the classes were organized was great. It was one subject at a time. Usually it would be two weeks, however sometimes they were one and three weeks long. I never had to worry about assignments for different classes or more than one test at a time. It was great.

There was even an employment specialist who worked with me to teach me how to write a resume, prepared me for interviews, and taught how the employer looks at everything. She always posted open positions in the community on a board and helped me tailor my resume to each position.

Also as I side note, I also attended university for one year prior to the community college. I hated it. The teachers did not know your name or even if you attended class. It was the worst educational experience I had.

So out of the three, I rank university the worst. Community college was better in that the class sizes were smaller and you really got to know your teachers and classmates. But above all, the Adult Education center was the best because you got to know your teachers, your classmates, it was easy to schedule a part time job around, there was no wasted time or classes, and only one subject to concentrate on at a time.

I have been a “homeschool mom” for nigh unto 25 years now. My oldest son is 29 years old and my youngest daughter is four. We will be homeschooling for another few years it looks like. We have used many different methods, as well as non methods. The best method we have found is the one we are using right now. We are living in Costa Rica and loving it.

Two years ago we sold everything and moved here to Costa Rica for a five year adventure. When we made the move we were concerned about our two youngest daughters who would be moving here with us. I researched private schools and decided on one my older daughter would attend here. She attended school for two months at the private school, after which time we pulled her out and proceeded to homeschool, again.

One of the reasons we had put her into the school was so that she could make friends and work on her Spanish. After a few days we saw this was not going to happen. All of the girls were afraid to talk to her because they were self conscious about their English and felt that it was not good enough. She did make friends with some of the braver boys, but she was not happy there with the situation.

Fot the past year and a half she has been homeschooling. When we agreed to her pleas for homeschooling we put some stipulations on it. We were both tired of homeschooling and had finally decided it was time to send the kids to school. For this reason she agreed she would be responsible for getting all of her work done, exercise everyday, and get out and make some friends so that she could polish up her Spanish.

It has proven very effective. I do have to preface this by saying that there were others of our children that it would not have worked with. Every child is different and has different outlooks and needs. For my daughter the “unschooling” has worked great and we are very happy with it. What does one of her days look like?

She gets up at 8:30 every morning during the school week. I will not even say when she gets up on the weekends! She gets up, drinks a glass of juice and packs up her swimming gear. She gets her 300 colones from her Dad for bus fare and walks the block down to catch the 9:15 city bus. She goes downtown to Heredia for her swim workout at the city pool. It is $20.00 for a one month pass. It is a beautiful 50 meter outdoor pool with all the lanelines etc. She gets her workout from a free online swimming class she is enrolled in through BYU Independent Studies Program. She walks over to the store and catches the bus home, arriving by 11:30.

When she gets home we all have lunch together and she gets started on her school work. The one rule we do enforce with her is no laptop until the school work is done. That is the only motivation she needs to get her school work done in a hurry. Her curriculum consits of a program we ordered online for $400.00, entire year included. It includes all of the basics and she seems to be progressing well. She is very conscientious about completing her school work as she plans to return to the States to attend college.

After her school work is completed my daughter spends part of her afternoon on-line keeping up with all of her high-5 friends from Costa Rica. For the first year she kept up with all of her myspace friends from the states. In the afternoons her school friends come by to pick her up. The walk to the park down the street or to town to look at the pet store, or buy food. Sometimes they will take a picnic to the park. In the evening she helps with dinner and clean up and has her chores to do.

Her friends all speak Spanish and her Spanish is very fluent at this point. We are very happy with the progress she has made and wonder about all the time we spent forcing out other children to get their school work done! She has gained so much more from this experience than she would have ever received from attending a regular high school. Yes she will miss prom, oh well maybe we will go spend a week at the beach for her graduation!

Students packing for a trip to another country are often confused - I know I was. It’s not hard to wonder how on earth you’ll manage to have everything you’ll need. After all, you won’t know anyone where you’re going, or even speak the language most times.

While no advice or tidbit of information can truly prepare someone to spend time in another country, there is some advice to be had. Most importantly, prepare early! Items like passports and vaccinations are extremely important, and may take a long time to get.

Of course, the only way to know exactly which visas and vaccinations you’ll need is to do some reading about the place you’re going. This reading can also help you prepare for customs requirements for your return trip - everyone likes to bring home gifts and it’s important not to buy something that could cause problems when you try to bring it back home.

Familiarizing yourself with the travel requirements, though, isn’t the only learning you’ll need to do. Each country has its own weather, culture, and expectations of travelers. It’s important to have some idea of what to expect when you step off the plane. However, remember that reading other peoples’ accounts can only go so far in preparing you for your own experiences!

Finally, the best advice I was given: Pack less clothing than you think you’ll need. You will almost certainly buy more clothes while you’re in the country. You’ll also want to remember that clothes, souvenirs, and gifts for family and friends back home take up space, so packing with some extra room in your suitcases is a good idea. I managed to pack an extra bag inside my suitcase, so when it came time for the trip home I had plenty of extra space. Still, you can always ship any non-essential items back home in the mail if you do run out of space.

So, when planning to study or travel abroad, a student’s best friend is planning - not procrastination. Spend a bit of time making a list of everything you’ll want to do, and what dates you’ll need to do it by. This should make study abroad a breeze.

Two years ago we decided to sell everything we owned, including my business and move to Costa Rica. My husband took early retirement from the Post Office and we moved south. Part of the motivation was that we wanted to get out of debt and get self reliant. Another reason was that we thought it would be good for our two youngest children living at home to live abroad for a few years. We have a five year plan and are enjoying the heck out of the adventure.

One thing we have discovered and wish that we had discovered 25 years ago when we began homeschooling our seven children,is that this is the best way to homeschool! Had we known then what we know now we would have made the move many years ago. Why you ask, would it be any better to homeschool abroad?

Reason number one is the fact that we are saving mucho dinero on teaching our children a foreign language. There is a saying that if you are trilingual you are European if you are bilingual you are south or central American and if you speak only one language you are American! We feel it is important for all people to speak more than one language, and most colleges share this belief. Most colleges now require at least two years of foreign language studies.

The second reason is the fact that every person should spend at least 6 months living in another country. When we first moved here we believed it would teach our daughters to appreciate all the comforts of the US. We just returned from our yearly journey to the States and they just kept complaining about wanting to go home.

Third would be hands on learning about another culture. We have travelled to Nicaragua, Panama and have a trip planned to Hondurus. The girls have learned much about different countries as well as different people. They can tell now which country people come from when they meet and talk to them.

The fourth benefit we have observed is our daughters have become very adaptable. Being adaptable is very important for all people no matter where they come from. It makes life easier and relieves stress in our lives. When we first moved here my youngest daughter as well as the rest of us were shocked that all the other children called her Chine. She is Chinese and here anyone that looks Chinese is automatically termed Chine. Now we are used to it and she comes when they call, though she does remind them that her name is Maleah.

The fifth reason we feel it is beneficial to homeschool abroad is that it is just plain old fun! Every month we plan a trip to a different part of the country, usually a beach we have not seen! The girls have sea shell collections, sand they like to play with and other treasures from the beach. My older daughter even has a picture of her with a surfer guy from Czech Republic.

If I could give any advice to fellow homeschoolers it would be to take a few chances. Maybe take a year or two of leave time and take the kids out of the country to homeschool abroad.