Sample Size„
Is there a specific reason that the ˙200-City Survey,Ó featured in February„JEMS didn_t utilize data from some of the largest county/regional EMS providers in the nation, such as Los Angeles, Dekalb, Fairfax, Miami-Dade and Broward counties? In order to get a true picture of the nation_s EMS system, this statistically significant group of providers should be included in the survey process.
Daniel J. Cuoco
Miami-Dade County (Fla.) Fire Rescue Dept.

Author David M. Williams, MS, responds: When„JEMS developed the 200-City Survey„ more than two decades ago, it was just 50 cities and the assumption was that the largest cities would be indicators for emerging EMS trends. Over the years, EMS has evolved, and so has the breadth of the survey.„
One very fair criticism has been why the survey doesn_t focus on the largest ˙EMS systemsÓ versus the ˙largest cities,Ó which are not one and the same. The simplest answer is based on logistics: 1) How would the largest EMS systems be identified?; and 2) How can we identify all of the entities providing service in those systems and access them? Not an easy undertaking.„
For now, the survey is what it is: the best available data. However, that_s not to say„JEMS won_t continue to evaluate the relevancy of the 200-city sample and whether the survey should change in future years. I_m open to it!„

Life-Saving Products
As a medic in the U.S. Army, I_m intimately familiar with North American Rescue Products_ (NARP) uniquely designed combat equipment, and I_ve used a wide array of the products to save lives in Iraq.„
I_m most proud to see the C-A-T tourniquet featured in the ˙Hands OnÓ section of February„JEMS. I_ve seen firsthand how the C-A-T has saved lives from serious trauma caused by bombs and bullets, and in May of last year, it saved my life. A roadside blast shattered my right tib/fib, ankle and foot. The damage to the soft tissue was so severe, most thought that if I lived, I would lose my leg. After nearly a week in a coma and several blood transfusions, I survived and kept the leg. Now, I_m going through physical rehab„ and spending time with my new bride. Thanks to NARP for making a product that_s truly at the top of its class.
CPL Greg Hogancamp, EMT-I
U.S. Army Combat Medic

Drawing Conclusions
The author of ˙Looking the PartÓ (April) brings up a valid point about appearance in relation to professionalism in the workplace, but I have some concerns about his impression of professionalism and what it means to not just appear to be a good provider, but actually be one.„
I was a professional tattoo artist and have tattoos all over my arms, neck, back and chest. When my son was born in 2004, I gave up my dream of tattooing and entered EMS as a wheel-chair driver in order to have health insurance and steady pay. I was initially met with the same obtuse mind_set that you described in your article.„ However, my attitude and customer service skills far exceeded many of my colleagues_ and within eight months, I had my EMT-B certification and was working on an ambulance full time, gaining much respect from peers„and superiors.„
It_s important to recognize that professionalism is 5% appearance and 95% attitude. I have met countless individuals who fit the ˙standardÓ of appearance but lacked the ability to engage patients, work well with team members, and gain respect and trust. If all agencies strive to find the best substance of personnel and not so much the best appearance, EMS in this country would improve exponentially.
Jeremy Clayton, NREMT-P

Author Gary Ludwig responds: I don_t know if I agree with everything you wrote, but I respect your opinions and commitment to the profession. You_re right that attitude has a lot to do with professionalism. But you said it yourself: You were initially met with ˙obtuse mindsetsÓ and had to work to gain their confidence. The„ problem is we don_t have eight months to gain the confidence of our patients when we show up at the door. We maybe have an hour.„

Learning Curve„
I just read the JEMS.com article, “NREMT Policy Change: Good for EMS,” about the need for a higher level of education for EMS providers, and I completely agree with what Dr. Bledsoe is saying. We’ll never be able to gain the respect of our medical colleagues until we can show that we have the same commitment to education that they have.„
The changes in the paramedic curriculum in the past several years have been very positive. Still, the fact remains that in any profession you enter. it doesn’t matter how smart you are or how many years of experience you have it’s your education (your degree) that confirms your position. Bottom line, if we expect to be treated like professionals, we’re going to have to be educated like professionals.„
Greg Coberley, NREMT-P

Corrections
The correct suggested retail price for the Bio Safe Protectant Lotion featured in May Hands On (p. 118) is $3.99Ï$49.99. For more information, visit„www.biosafe-inc.com.
The photographs in the April Call to Action (p. 14) were provided by Rony Ramia, MD, the trauma surgeon who cared for the patient in the case described. We regret the misspelling of his last name in the original publication.„