EMT-B Certification

[MrBrown]

Suburban and urban places can live with BLS care support for the 10-15 minute drives to the hospital. Ultimately, its getting to the hospital as quickly as possible that will save those critical patients.

While time is a factor and should not be under appreciated in context of the larger clinical picture the American mentality of throw everybody on a spine board and race them to hospital because that is what our poorly written textbook told us to do is not really the best approach.

 

[Tigger]

I think it depends on the area your in. Some place rural like Tennessee where the hospital may be 30 minutes or more away, yes. Suburban and urban places can live with BLS care support for the 10-15 minute drives to the hospital. Ultimately, its getting to the hospital as quickly as possible that will save those critical patients. And for the non-critical patients in rural areas, the medics can make sure they stay that way.

Sorry, but I don't think it's ok for someone in significant distress to have to wait an additional 15 minutes to be seen by a provider that can actually figure out what is wrong, and then maybe start to treat. There is nothing sadder than loading someone with significant abdominal pain or an isolated orthopedic injury and telling them that there is absolutely nothing you can do for them except to take them to the hospital. And please, no one give me the "put them on high flow o2, it'll make them feel better" spiel, I've about had enough of that mindset.

I love my job and I do everything I can for my patients, but at my present level it isn't usually anywhere close to enough.

Though there is that idea from The House of God that doing nothing is doing something....


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[traumaluv2011]

And a paramedic can diagnose every call they can get? They can start an IV and give them fluids or meds as needed, but can't they do the same exact thing in the hospital while a doctor figures out the problem? And yes, the hospital can get busy, but they prioritize most patients based on the seriousness of their condition.

I'm not bashing paramedics, I think they are very useful, but if a person requires surgery, psychiatric evaluation, etc. it is better to get them to the hospital as quick as they can. Yeah, I guess having a paramedic is a safe route should the patient's condition worsen en route. I think having ambulances with a Medic and at least one Basic would be the optimal crew.

The paramedic can do what is needed and the basic can assist the medic or drive.

 

[JPINFV]

And a paramedic can diagnose every call they can get?

The question is not if a diagnosis can be made or not, but how specific of a diagnosis can be made, and with what accuracy. Absent the ability to work up a patient further, an EMT can surely diagnose a patient with chest pain. Similarly, what's just as important, if not more so, than any specific working diagnosis are the differential diagnoses that are also being considered.

I'm not bashing paramedics, I think they are very useful, but if a person requires surgery, psychiatric evaluation, etc. it is better to get them to the hospital as quick as they can. Yeah, I guess having a paramedic is a safe route should the patient's condition worsen en route. I think having ambulances with a Medic and at least one Basic would be the optimal crew.

Whether speed matters depends on the condition, and the condition cannot be determined without an assessment.

 

[Handsome Robb]

In my county an ambulance has to have an I/P or P/P onboard to be on the street. From the intermediate stand point, I liked it because I could reduce the medic's workload by drawing up meds, starting an IV and so forth which *most* basics can't do. From the Medic standpoint, it's nice to have a partner who can do more than drive/bag/lift/pass me things. No offense meant, just my .02

 

[Tigger]

And a paramedic can diagnose every call they can get? They can start an IV and give them fluids or meds as needed, but can't they do the same exact thing in the hospital while a doctor figures out the problem? And yes, the hospital can get busy, but they prioritize most patients based on the seriousness of their condition.

I'm not bashing paramedics, I think they are very useful, but if a person requires surgery, psychiatric evaluation, etc. it is better to get them to the hospital as quick as they can. Yeah, I guess having a paramedic is a safe route should the patient's condition worsen en route. I think having ambulances with a Medic and at least one Basic would be the optimal crew.

The paramedic can do what is needed and the basic can assist the medic or drive.

The point of having the paramedic around is not as a precaution against the patient getting worse. The purpose of having providers in the field with an actual clinical knowledge base is to make people better. I hate being unable to call for ALS because the patient is "stable." Does anyone think nana doesn't want those pain meds after she slipped in the bathroom and broke her hip? Hopefully not, but unless nana is also circling the drain or dead on the floor, it's unlikely that ALS will be paying us a visit anytime soon.

And yes, she will be getting the same treatment in the hospital, but why should she have to wait when there are providers available to actually help her? Aren't we supposed to be "bringing the hospital to the patient" with our "mobile emergency rooms?"

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[MrBrown]

Does anyone think nana doesn't want those pain meds after she slipped in the bathroom and broke her hip? Hopefully not, but unless nana is also circling the drain or dead on the floor, it's unlikely that ALS will be paying us a visit anytime soon.
.

So if you ring up for ALS (ICP) for pain relief they will not come?

 

[Handsome Robb]

It's not an issue where I work seeing as all the trucks have pain management, wether it be nitrous or narcotics, but from friends and people who I have talked to who work in BLS/ALS systems, no. If the system is busy, and/or there isn't a truck available you won't get it unless it is a patient who meets that system's ALS criteria.

 

[MrBrown]

If the system is busy, and/or there isn't a truck available you won't get it unless it is a patient who meets that system's ALS criteria.

Gosh silly Brown for thinking "pain" was somehow criteria for requesting people capable of providing "pain relief".

Rob, do you haz teh entonox (nitrous)?

 

[Tigger]

So if you ring up for ALS (ICP) for pain relief they will not come?

I don't know if they would flat out deny me, but the ETA would be absolutely awful.

Seriously, there are more ERs in the city of Boston than are Boston EMS ALS units. My company's paramedics are all committed to a 911 contract far from Boston so we would have to request ALS from the city, and they are apt to probably just laugh at us unless the person is nearly dead. Pain managment? Hah we don't got no pain management.

 

[medicdan]

Heh. I hear you. I work for a company that has more ALS resources in the city, but certainly get turned down for medics often enough. I've learned to be more forceful in my insistence with dispatch when I really need it.

At the end of the day, though, when there's nothing available all we can do is treat to our capabilities, transport and document our request for ALS.

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[MrBrown]

Heh. I hear you. I work for a company that has more ALS resources in the city, but certainly get turned down for medics often enough. I've learned to be more forceful in my insistence with dispatch when I really need it.

At the end of the day, though, when there's nothing available all we can do is treat to our capabilities, transport and document our request for ALS.

Are they declining you because there are no ALS resources in the grid free to send or because they do not feel the request (e.g. pain relief) is worthy of an ALS resource?

Here, if you ring up and request ALS (Intensive Care) you get it no matter what

 

[Tigger]

Are they declining you because there are no ALS resources in the grid free to send or because they do not feel the request (e.g. pain relief) is worthy of an ALS resource?

Here, if you ring up and request ALS (Intensive Care) you get it no matter what

Someone with more knowledge of Boston EMS will have to answer that. All I know is that if you call in with a cardiac arrest of something of similar nature, you usually get ALS quickly. If you call for pain control, it takes a lot longer. How they deploy their ALS is not something I yet understand. They will always give you an ETA, but the hospital is almost always closer, unless you have patient that is (nearly) dead, then suddenly the ETA is better.

Many providers are also quite afraid to call for ALS. The medics come with a city BLS basic truck as well (to drive the medic truck to the ER), so there are a lot of eyes theoretically judging you. It makes no difference to me if four city guys think I am crappy provider for calling ALS on a perceived BLS call, but it does to some people.

That all notwithstanding, this does expose a weakness of Boston's EMS system. There are so few ALS units that they are often tied up, so even serious cases become "scoop and screws." This makes pain control or even simpler things like Zofran for nausea all but impossible to get outside of the hospital. To be fair, city BLS crews go through a six month fulltime academy that includes an additional three months in the classroom, the basics are said to "assess at an ALS level."

 

[usalsfyre]

I see it less of a weakness with Boston's system and more of a weakness with the EMT-Basic level of provider. There's no reason the AEMT level couldn't provide things like Zofran and sensible narcotic pain control given the appropriate education.

 

[Tigger]

I see it less of a weakness with Boston's system and more of a weakness with the EMT-Basic level of provider. There's no reason the AEMT level couldn't provide things like Zofran and sensible narcotic pain control given the appropriate education.

But that's the thing, there are no AEMT level providers, even though I would bet a Boston basic has a knowledge base that is comparable, just without the skills. I am all about EMS not being dragged down with skill obsession, but with an increase in knowledge needs to come some increase in scope. As it is now, only six trucks during the day and three at night are capable of delivering Zofran, as an example. At least they can give a neb or nasal nalaxone now, therefore not tying ALS up for these medications.

 

[hippocratical]

Correct me if I'm wrong (and I probably am...) but isn't the role of EMS to basically stop people in emergency situations from dying?

Your level of training determines how 'good' you might be at this process, but essentially that's our purpose? Paramedics have more experience and toys than an EMT-B, but we all have the same aim: to press the pause button until they can be "cured" at hospital.

Sorry to be flippant, but I'd like to see any level of EMS provider actually heal a broken bone, remove a tumor, or de-crazy a first onset schizophrenia pt. That's why we have docs in hospitals.

One day they'll invent an Dr Horrible's freeze ray and then we're totally out of work

 

[Shishkabob]

How about reverse an anaphalytic reaction?

How about cardiovert a lethal rhythm?

How about convert symptomatic SVT?

How about reversing respiratory arrest?

How about stopping an asthma / COPD attack?

How about reviving a diabetic?



There's plenty that EMS (namely Paramedics) can "cure" without the need for a hospital, all of those potentially lethal.

 

[Chief Complaint]

How about reverse an anaphalytic reaction?

How about cardiovert a lethal rhythm?

How about convert symptomatic SVT?

How about reversing respiratory arrest?

How about stopping an asthma / COPD attack?

How about reviving a diabetic?



There's plenty that EMS (namely Paramedics) can "cure" without the need for a hospital, all of those potentially lethal.

Nailed it.

 

[hippocratical]

There's plenty that EMS (namely Paramedics) can "cure" without the need for a hospital, all of those potentially lethal.

so EMT-Bs are useful!

^_^

 

[MrBrown]

There's plenty that EMS (namely Paramedics) can "cure" without the need for a hospital, all of those potentially lethal.

You are curing nothing, you are relieving symptoms or providing reversal of acute exacerbations of a chronic disease.

Are you curing the diabetes or underlying heart disease or autoimmune disorder No.

Does that mean it is not important for Paramedics to be available to provide such service? No it does not.