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Expertise / experience (Residency-trained ED MD vs. EMTP). Personnel. Imaging. Labs. Drugs. Resources. Specialists and subspecialists.What magical things does the ER have that an ALS ambulance does not bring to the table for initial stabilization of this patient?
Granted, probably none of the treatment differs in the very early phases of resuscitation, but to pretend that an ambulance is the same as an ED is silly.
Everyone will sit here and say "cut her a break, it was a pediatric call and a really sick kid" but the expectation of paramedics is to able to handle a high stress situation no matter the age of the patient. That is why we get paid to go out and treat sick people, its the expectation that we are able to do that.
That's a much easier thing to talk about than to accomplish.
It just isn't true that just because someone has graduated a paramedic program that they are properly equipped to deal with these unusual and highly stressful situations. It should be that way - I think everyone agrees on that - but it isn't.