Emergency Medical Advisory Committee: Fill & Download for Free

I don’t work for either service but I am a paramedic in the northeast USA and know a little about the FDNY Bureau of EMS.You need to an American citizen to be employed by the FDNY (See firefighter-career-faq)I highly doubt your Australian medic cert will transfer automatically to the United States-> State of New York-> NYC REMAC (Regional Emergency Medical Advisory Committee ) paramedic Cert…..highly doubt it. (see ems-eligibility-requirements)To uproot your life, move to the USA, obtain the residency requirements to be hired by either service, obtain the necessary certifications, endure an entire hiring process, only to be paid sub-standard pay compared to other professions…I would not recommend it.

'Is the human body not capable of dealing with the flu without any preventive medication?'.Flu (influenza) is a seasonal disease, typically prevalent in winter in the US. Many among the unvaccinated contract and survive the flu each year suggesting many humans are capable of dealing with it without preventive medicine. However, flu strains tend to be different from year to year and strains circulating one year can be more deadly than those in other years.The 1918 flu pandemic - Wikipedia is estimated to have killed at least 50 million.While not as deadly, subsequent flu pandemics, Influenza pandemic - Wikipedia, such as those in 1957, 1968 and 2009 also killed many.Even today, according to the WHO, seasonal flu leads to an estimated 3 to 5 million global cases of severe illness with ~250000 to 500000 deaths each year (1).Typically, flu lethality disproportionately affects the very young, the very old and the already ill, the 1918 and 2009 pandemics being exceptions in disproportionately felling those between 20 and 40 years of age.Already, apparently the major flu strain circulating in 2017, the influenza A strain H3N2, has led to the headline-grabbing death of an unvaccinated 20 year old mom of two in Arizona (2).Further, seasonal flu is consistently a bigger problem for the older in the US, emerging as the major cause of death among those aged 65 or older, often not directly but as a result of pneumonia from secondary bacterial infections, speculatively an outcome of weakened immune system (3, 4).'Why are flu and flu shots such a big deal in the US? '.Different countries recommend vaccines for different diseases based on their region-specific disease profiles and economic capability. In the US, vaccine recommendations are made by the Advisory Committee on Immunization Practices - Wikipedia (ACIP) which publishes annual flu vaccine recommendations.Flu vaccines were licensed in the US in 1968 and only began to be included in the pediatric schedule (specifically for those aged 6 to 24 months) in 2004 (5). Starting in 2000, ACIP began incrementally increasing its annual vaccination recommendations to include ~84% of the US population by 2009. In 2010, the ACIP expanded its influenza vaccine recommendation further to all US residents >6 months of age (6), the rationale being the 2009 pandemic H1N1 flu outbreak, where those with greater risk for complications or more severe infections were found to beAdults <50 years of age (7).Those with obesity (8, 9).Specific ethnicities (10, 11).Postpartum women (12, 13, 14, 15).Bigger Picture Look on Current Flu Shots: A Sub-optimal Solution to a Real ProblemPush for flu vaccines is predicated on two notions, that theyEngender milder symptoms compared to those in the unvaccinated.Reduce risk of spread to vulnerable groups (the very young, the elderly or already ill), a consequence of herd immunity.Problem with current flu vaccines is a hit-or-miss situation since their efficacy varies greatly from year to year depending on how well the strains used in the vaccine match those dominating the circulation in a given year (see below from 16, emphasis mine).'The cornerstone of influenza prevention and epidemic control is strain-specific vaccination. Since influenza viruses are subject to continual antigenic changes (“antigenic drift”), vaccine updates are recommended by the WHO each February for the Northern Hemisphere and each September for the Southern Hemisphere. This guidance relies on global viral surveillance data from the previous 5 to 8 months and occurs 6 to 9 months before vaccine deployment. In addition, there are always several closely related strains circulating; therefore, experts must combine antigenic and genetic characterization and modeling to predict which strains are likely to predominate in the coming season.'See below from 17, emphasis mine.'Seasonal influenza outbreaks predictably occur each year and cause an estimated 250,000 to 500,000 annual deaths worldwide (WHO, 2008). Pandemics are highly unpredictable, but pose an even greater threat when they occur. There have been 4 distinct pandemics in the 20th and into the 21st century: 1918, 1957, 1968, and 2009. The worst of these, the 1918 H1N1 influenza pandemic, resulted in 50–100 million deaths globally (WHO, 2014). Despite this substantial disease burden, licensed vaccines provide suboptimal protection against seasonal influenza (typically ranging from 10% to 60%), need to be updated each year, and provide little or no protection against new pandemic influenza strains (CDC, 2017).A universal flu vaccine that could protect against most seasonal flu strains would be a far better option. However, substantial hurdles range from vaccine design to what represents protective immunity and how to assess it to how to produce such a vaccine.'Obviously, a universal flu vaccine would be a better solution. Hurdles in the way include figuring out optimal vaccine design, specifically which antigens to include, research on and agreement about the types of immune response that best reflect protection, i.e., correlates of protection, and appropriate methods to produce vaccine such that it retains capacity to mimic as much as possible ability to drive infection-like immunity that is robust and long-standing while still being safe. Greater public support, more funding for flu research and development, better ideas and more creativity, all these are needed to improve this sub-optimal status quo.Bibliography1. World Health Organization. "Barriers of influenza vaccination intention and behavior: a systematic review of influenza vaccine hesitancy 2005–2016." (2016). http://apps.who.int/iris/bitstream/10665/251671/1/WHO-HIS-TTi-GAP-16.2-eng.pdf2. A mother got the flu from her children — and was dead two days later3. Thompson, William W., et al. "Mortality associated with influenza and respiratory syncytial virus in the United States." Jama 289.2 (2003): 179-186. https://pdfs.semanticscholar.org/6fc2/7fbd827b21dfd54e20144678fd4262f1afdb.pdf4. Matias, Gonçalo, et al. "Estimates of hospitalization attributable to influenza and RSV in the US during 1997–2009, by age and risk status." BMC public health 17.1 (2017): 271. https://pdfs.semanticscholar.org/b299/818f0a5225968e4fa118e39e3824994cff14.pdf5. Harper, Scott A., et al. "Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices (ACIP)." Morbidity and Mortality Weekly Report: Recommendations and Reports 54.8 (2005): 1-41. https://www.researchgate.net/profile/Carolyn_Bridges2/publication/10753336_Bridges_CB_Harper_SA_Fukuda_K_et_al_Prevention_and_control_of_influenza_Recommendations_of_the_Advisory_Committee_on_Immunization_Practices_ACIP_MMWR_Recomm_Rep_52_1-34_quiz_CE1-4/links/00b7d529dd54d69f72000000.pdf6. Grohskopf, Lisa A., et al. "Prevention and control of seasonal influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices—United States, 2017–18 influenza season." American Journal of Transplantation 17.11 (2017): 2970-2982. http://onlinelibrary.wiley.com/doi/10.1111/ajt.14511/epdf7. Fiore, Anthony E., et al. Prevention and control of influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2010. Department of Health and Human Services, Centers for Disease Control and Prevention, 2010. https://www.cdc.gov/mmwr/pdf/rr/rr5908.pdf8. Louie, Janice K., et al. "A novel risk factor for a novel virus: obesity and 2009 pandemic influenza A (H1N1)." Clinical Infectious Diseases 52.3 (2011): 301-312. https://pdfs.semanticscholar.org/a8b2/c28e98139dc24d160f54d5ced3e0427e0a26.pdf9. Morgan, Oliver W., et al. "Morbid obesity as a risk factor for hospitalization and death due to 2009 pandemic influenza A (H1N1) disease." PloS one 5.3 (2010): e9694. http://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0009694&type=printable10. Castrodale, L., et al. "Deaths related to 2009 pandemic influenza A (H1N1) among American Indian/Alaska Natives-12 states, 2009." Morbidity and Mortality Weekly Report 58.48 (2009): 1341-1344. Deaths Related to 2009 Pandemic Influenza A (H1N1) Among American Indian/Alaska Natives --- 12 States, 200911. Wenger, Jay D., et al. "2009 Pandemic influenza A H1N1 in Alaska: temporal and geographic characteristics of spread and increased risk of hospitalization among Alaska Native and Asian/Pacific Islander people." Clinical Infectious Diseases 52.suppl_1 (2011): S189-S197. https://www.researchgate.net/profile/John_Redd2/publication/50264786_2009_Pandemic_Influenza_A_H1N1_in_Alaska_Temporal_and_Geographic_Characteristics_of_Spread_and_Increased_Risk_of_Hospitalization_among_Alaska_Native_and_AsianPacific_Islander_People/links/5460d1390cf2c1a63bff71ef.pdf12. Siston, Alicia M., et al. "Pandemic 2009 influenza A (H1N1) virus illness among pregnant women in the United States." Jama 303.15 (2010): 1517-1525. https://www.researchgate.net/profile/Katherine_Seib/publication/43226995_Pandemic_2009_Influenza_AH1N1_Virus_Illness_Among_Pregnant_Women_in_the_United_States/links/004635367ec7ea16ba000000/Pandemic-2009-Influenza-AH1N1-Virus-Illness-Among-Pregnant-Women-in-the-United-States.pdf13. Creanga, Andreea A., et al. "Severity of 2009 pandemic influenza A (H1N1) virus infection in pregnant women." Obstetrics & Gynecology 115.4 (2010): 717-726.14. Jamieson, Denise J., et al. "H1N1 2009 influenza virus infection during pregnancy in the USA." The Lancet 374.9688 (2009): 451-458. http://med-fom-apt.sites.olt.ubc.ca/files/2012/05/H1N1-and-Pregnancy.pdf15. Louie, Janice K., et al. "Severe 2009 H1N1 influenza in pregnant and postpartum women in California." New England Journal of Medicine 362.1 (2010): 27-35. http://www.nejm.org/doi/pdf/10.1056/NEJMoa091044416. Paules, Catharine I., et al. "Chasing Seasonal Influenza—The Need for a Universal Influenza Vaccine." New England Journal of Medicine (2017). http://www.nejm.org/doi/pdf/10.1056/NEJMp171491617. Paules, Catharine I., et al. "The Pathway to a Universal Influenza Vaccine." Immunity 47.4 (2017): 599-603.Thanks for the R2A, Santosh Kumar.

Culture often trumps science even when it's to the detriment of health. Unnecessary and even harmful suppression of certain types of inflammation falls in such a category. The cultural aspect here perhaps started with fever phobia (1). Fever is after all one of the most commonly recognized signs of generalized, widespread inflammation in the body. Thus this answer focuses on how as an example of inflammation it's become common practice to reduce fever even though doing so may often be counter-productive in more than one way.Fever phobia is exaggerated fear of its potentially serious, irreversible consequences, such as febrile seizures, brain damage, coma, convulsions, dehydration and even death, especially in children (2). Coined in 1980 (3), even today careful meta-analyses of studies probing the public's, and in particular parents', attitude to fever find that this exaggerated fear of fever has hardly abated (2), meaning it's stably entrenched as a cultural attribute.So what was the source or impetus for fever phobia in recent times? Quite plausibly, reports of higher risks of death from pediatric febrile seizures helped imprint a cultural fear of fever. For example, as far back as 1950 a study reported a 11% mortality risk for children with febrile seizures (4). Since most parents have limited knowledge of fever especially its many benefits (5, 6), fear of febrile seizures quickly permeated and became embedded culturally. This even when studies find up to a third of children brought to clinics aren't truly febrile (1, 7, 8, 9). Some examples of fever phobia:85% of surveyed US parents reported they'd wake a child to administer antipyretics (10) even though pediatricians recommend against it (11).33 to 65% of surveyed UAE and Israeli parents reported giving acetaminophen for temperatures <38oC, i.e., for temperatures not likely to be fever (12, 13).74% of surveyed Canadian parents considered fever to be dangerous and 90% always attempted to treat it (14).Multiple other sources including but not limited to pharmaceutical companies, the media and pediatricians further helped embed the cultural fear of fever. For example, studies frequently find that pediatricians widely perceive fever to be dangerous (15) and advocate treating even mild fevers with antipyretics. For e.g., a 1992 survey found 65% of pediatricians perceived fevers to be dangerous and 72% often or always recommended antipyretic Rx (11).It's only much more recently that much larger, much more thorough studies found that long-term mortality risk isn't increased in children with febrile seizures. For e.g., a Danish study on 1675643 children (yes, a study with >1 million children!) born between 1977 and 2004 found 132 of 100000 children died within 2 years of a febrile seizure compared to 67 among those who didn't (16), i.e., ~2X increased risk. However, more careful analysis showed short-term mortality risk among children with simple febrile seizure, i.e., no recurrence, was similar to those without. The short-term mortality risk was only increased among those with recurrent febrile seizures, which 'was partly explained by pre-existing neurological abnormalities and subsequent epilepsy' (16). More importantly, long-term mortality rates were similar among children who either experienced febrile seizures or didn't. Moreover recent studies suggest a strong influence of genetic risk factors for recurrent, familial febrile seizures (17, 18). Since such recurrent febrile seizures are much more rare, specific genetic risk factors thus imply vast majority of fevers, especially in children, have low risk for them and for their recurrence.At least four problems ensue from widespread exaggerated perception of the danger of fever and the knee-jerk response to immediately reduce it.One, studies suggest antipyretics don't prevent febrile seizures (19, 20, 21, 22).Two, antipyretics themselves can have severe, though rare, side-effects such as liver or renal failure, GI tract ulcers (1) and even Stevens-Johnson syndrome (23) or asthma (24, 25).Three, often parents inadvertently compound such risks by giving incorrect doses of antipyretics (12). For e.g., a study found as many as 50% of US parents did so (26).Four, antipyretics such as paracetamol may delay recovery from infections or impede generation of effective immune responses to vaccines.Antipyretics delay malaria parasite clearance for example (27).Widespread antipyretic use may even help spread infectious diseases such as flu (28), perhaps because patients stay sick and retain higher infectious viral titers longer.In recent years, it's become more commonplace for pediatricians (29, 30, 31, 32) and even the US Advisory Committee on Immunization Practices (ACIP) (33) to recommend prophylactic antipyretic Rx prior to vaccinations to minimize the febrile response even though this is counter-productive. For e.g., individuals pre-treated with antipyretics have decreased immune responses to vaccines. This is seen not just in children (to DTaP + HBV + IPV/Hib*) (34) but also in adults (to HBV) (35).* DTaP = Diphtheria-Tetanus-acellular Pertussis vaccine; HBV = Hepatitis B vaccine; IPV = Inactivated Polio vaccine; Hib = Haemophilus influenzae vaccine.Bottomline, such a state of affairs suggests scientists communicate poorly with medical doctors and both communicate poorly with the general public. As a result, both doctors and the general public are less well aware of the more recently discovered myriad benefits of inflammation and fever. This has allowed older cultural beliefs to stay entrenched and thus trump science in the optimal management of inflammation in general and of fever in particular.Bibliography1. Wallenstein, Matthew B., et al. "Fever literacy and fever phobia." Clinical pediatrics 52.3 (2013): 254-259.2. Purssell, Edward, and Jacqueline Collin. "Fever phobia: The impact of time and mortality–A systematic review and meta-analysis." International journal of nursing studies (2015).3. Schmitt, Barton D. "Fever phobia: misconceptions of parents about fevers." Archives of Pediatrics & Adolescent Medicine 134.2 (1980): 176.4. Ekholm, Erik, and Kalevi Niemineva. "On Convulsions in Early Childhood and Their Prognosis An investigation with follow‐up examinations of patients treated for convulsions at the Children's Clinic of Helsinki University." Acta paediatrica 39.1 (1950): 481-501.5. Evans, Sharon S., Elizabeth A. Repasky, and Daniel T. Fisher. "Fever and the thermal regulation of immunity: the immune system feels the heat." Nature Reviews Immunology 15.6 (2015): 335-349. http://www.nature.com/nri/journal/v15/n6/pdf/nri3843.pdf6. Harden, L. M., et al. "Fever and sickness behavior: Friend or foe?." Brain, behavior, and immunity 50 (2015): 322-333. https://www.researchgate.net/profile/Joachim_Roth/publication/280116340_Fever_and_sickness_behavior_Friend_or_foe/links/55b5003f08ae9289a08a65d9.pdf7. Casey, Rosemary, et al. "Fever Therapy: An Educational Intervention for Parents." Pediatrics 73.5 (1984): 600-603. http://www.healthnet.org.np/ebook/imci/fever/05.1.%20Detecting%20fever%20and%20choice%20of%20antipyretics/CASEY%20R.1984.PDF8. Wammanda, R. D., and S. O. Onazi. "Ability of mothers to assess the presence of fever in their children: Implication for the treatment of fever under the IMCI guidelines." Annals of African medicine 8.3 (2009). http://www.ajol.info/index.php/aam/article/viewFile/48351/347069. Graneto, JOHN W., and DAVID F. Soglin. "Maternal screening of childhood fever by palpation." Pediatric emergency care 12.3 (1996): 183-184.10. Crocetti, Michael, Nooshi Moghbeli, and Janet Serwint. "Fever phobia revisited: have parental misconceptions about fever changed in 20 years?." Pediatrics 107.6 (2001): 1241-1246.11. May, Ariane, and Howard Bauchner. "Fever phobia: the pediatrician's contribution." Pediatrics 90.6 (1992): 851-854.12. Betz, Martin G., and Anton F. Grunfeld. "‘Fever phobia’ in the emergency department: a survey of children's caregivers." European Journal of Emergency Medicine 13.3 (2006): 129-133.13. Bilenko, Natalya, et al. "Determinants of antipyretic misuse in children up to 5 years of age: a cross-sectional study." Clinical therapeutics 28.5 (2006): 783-793.14. Enarson, Mark C., et al. "Beliefs and Expectations of Canadian Parents Who Bring Febrile Children for Medical Care." Pediatrics (2012): peds-2011. http://pediatrics.aappublications.org/content/pediatrics/early/2012/09/04/peds.2011-2140.full.pdf15. El-Radhi, A. S. "Fever management: Evidence vs current practice." World J Clin Pediatr 1 (2012): 29-33. http://www.wjgnet.com/2219-2808/ejournals/WJCPv1i4.pdf#page=1516. Vestergaard, Mogens, et al. "Death in children with febrile seizures: a population-based cohort study." The Lancet 372.9637 (2008): 457-463. https://www.researchgate.net/profile/Jakob_Christensen/publication/23161381_Death_in_children_with_febrile_seizures_a_population-based_cohort_study/links/0fcfd50a5f0dd8f6ce000000.pdf17. Saghazadeh, Amene, Mario Mastrangelo, and Nima Rezaei. "Genetic background of febrile seizures." Reviews in the Neurosciences 25.1 (2014): 129-161. Genetic background of febrile seizures18. Boillot, Morgane, et al. "Novel GABRG2 mutations cause familial febrile seizures." Neurology Genetics 1.4 (2015): e35. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4811385/pdf/NG2015000638.pdf19. Schnaiderman, D., et al. "Antipyretic effectiveness of acetaminophen in febrile seizures: ongoing prophylaxis versus sporadic usage." European journal of pediatrics 152.9 (1993): 747-749.20. van Stuijvenberg, Margriet, et al. "Randomized, controlled trial of ibuprofen syrup administered during febrile illnesses to prevent febrile seizure recurrences." Pediatrics 102.5 (1998): e51-e51. http://repub.eur.nl/pub/8923/9794981.pdf21. Esch, Adrianus van, et al. "A study of the efficacy of antipyretic drugs in the prevention of febrile seizure recurrence." Ambulatory Child Health 6.1 (2000): 19-25.22. El-Radhi, A., and W. Barry. "Do antipyretics prevent febrile convulsions?." Archives of disease in childhood 88.7 (2003): 641. http://adc.bmj.com/content/88/7/641.full.pdf23. Maggio, Maria Cristina, et al. "Stevens–Johnson syndrome and cholestatic hepatitis induced by acute Epstein–Barr virus infection." European journal of gastroenterology & hepatology 23.3 (2011): 289.24. El-Radhi, A. Sahib M. "Why is the evidence not affecting the practice of fever management?." Archives of disease in childhood 93.11 (2008): 918-920.25. McBride, John T. "The association of acetaminophen and asthma prevalence and severity." Pediatrics 128.6 (2011): 1181-1185. http://pediatrics.aappublications.org/content/pediatrics/128/6/1181.full.pdf26. LI, SIU FAI, BRITT LACHER, and ELLEN F. CRAIN. "Acetaminophen and ibuprofen dosing by parents." Pediatric emergency care 16.6 (2000): 394-397.27. Brandts, Christian H., et al. "Effect of paracetamol on parasite clearance time in Plasmodium falciparum malaria." The Lancet 350.9079 (1997): 704-709.28. Earn, David JD, Paul W. Andrews, and Benjamin M. Bolker. "Population-level effects of suppressing fever." Proceedings of the Royal Society of London B: Biological Sciences 281.1778 (2014): 20132570. http://rspb.royalsocietypublishing.org/content/royprsb/281/1778/20132570.full.pdf29. Kohl, Katrin S., et al. "Fever after immunization: current concepts and improved future scientific understanding." Clinical infectious diseases 39.3 (2004): 389-394. Current Concepts and Improved Future Scientific Understanding30. Marcy, S. Michael, et al. "Fever as an adverse event following immunization: case definition and guidelines of data collection, analysis, and presentation." Vaccine 22.5 (2004): 551-556. http://www.lareb.nl/LarebCorporateWebsite/media/publicaties/vaccine2004_1567.pdf31. Lewis, Karen, et al. "The effect of prophylactic acetaminophen administration on reactions to DTP vaccination." American Journal of Diseases of Children 142.1 (1988): 62-65.32. Moshe, M., et al. "Acetaminophen prophylaxis of adverse reactions following vaccination of infants with diphtheria-pertussis-tetanus toxoids-polio vaccine." The Pediatric infectious disease journal 6.8 (1987): 721-724.33. Centers for Disease Control and Prevention. Pertussis vaccination: use of acellular pertussis vaccines among infants and children recommendations of the Advisory Committee on Immunization Practices (ACIP). Pertussis Vaccination: Use of Acellular Pertussis Vaccines Among Infants and Young Children Recommendations of the Advisory Committee on Immunization Practices (ACIP)34. Prymula, Roman, et al. "Effect of prophylactic paracetamol administration at time of vaccination on febrile reactions and antibody responses in children: two open-label, randomised controlled trials." The Lancet 374.9698 (2009): 1339-1350. https://ttuhsc.edu/amarillo/som/ped/documents/april10jc.pdf35. Doedée, Anne MCM, et al. "Effects of prophylactic and therapeutic paracetamol treatment during vaccination on hepatitis B antibody levels in adults: two open-label, randomized controlled trials." PloS one 9.6 (2014): e98175. http://journals.plos.org/plosone/article/asset?id=10.1371%2Fjournal.pone.0098175.PDFThanks for the R2A, Adriana Heguy.