# Things we can do nothing about?



## tsuna51 (Jul 27, 2011)

If you get called for something like a stubbed toe, what would you do and say to the patient? Would you just tell them that there is nothing you can do for it and still offer a ride to the hospital/make them sign an AMA if they don't want to? I was just wondering because my teacher said something about how if they call you then you should always offer a ride to the hospital.


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## JPINFV (Jul 27, 2011)

Depends on local protocols and if paramedics are empowered to perform a paramedic initiated refusal of care.


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## WuLabsWuTecH (Jul 27, 2011)

It depends on your department protocol.  In the rural department I am on, if it's something that is not urgent and nothing we can do for it, we'll tell them that, and tell them if they want it checked out their best bet is to go to the ER themselves or call their doctor and we'll have them sign a refusal.  Of course taking them to the hospital also adds another hour to an hour and a half to our run time taking us out of service as the sole provider for a 190 square mile area for that length of time...  If they insist on going via squad, we do take them.

In the city, our transport time is 6 minutes on the off chance that we hit all the lights red, so we'll usually take them since turfing them would take more time.

That being said, be wary of those "little" calls.  Our department was dispatched for knee pain, and we walked in with just a first in bag (it's just knee pain, how bad can it be right?) and we looked like we were caught with our pants down when we got there and she was a full arrest!  (For those that are interested, it was a PE caused by a clot in her knee and by the time we got there, with a 15 minute response time, it had dislodged).


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## DesertMedic66 (Jul 27, 2011)

It all depends on your protocols and your company. For my company we are not allowed to tell a patient no they don't need an ambulance transport. No matter what they call us for we are "more then happy" to take them to the hospital. If they want to refuse transportation then we have a "wonderful" 12 step process to help change their mind. If they still say no then we let them sign the paper. 

Now I think all that ^ is BS even though I have to do it. IMO I believe that the ambulance crew should be able to decide if the patient needs to go or not. I would love to be able to say "you don't need an ambulance. Call a taxi or hop in your car and drive to the hospital for your hang-nail".


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## tsuna51 (Jul 27, 2011)

Oh ok, thanks guys. I am taking my final for my program tomorrow but I just feel like if I get hired somewhere then I am just expected to know what to do in every situation. I am really confident with my skills, but I just feel like I am unprepared to deal with a situation by myself without being told by the people I'm riding along with. It seems like it is mostly spelled out in the local protocols though.


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## WuLabsWuTecH (Jul 27, 2011)

any place that you work for, well any reputable place that you work for will put you on as a third man or even as a fourth man until you get the hang of things.  you are not expected to know what to do in every situation your first day out! (any anyone who makes that assumption is an idiot)


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## Elk Oil (Jul 27, 2011)

tsuna51 said:


> Oh ok, thanks guys. I am taking my final for my program tomorrow but I just feel like if I get hired somewhere then I am just expected to know what to do in every situation. I am really confident with my skills, but I just feel like I am unprepared to deal with a situation by myself without being told by the people I'm riding along with. It seems like it is mostly spelled out in the local protocols though.



I know that lots of people take not knowing something as a sign of weakness, but don't get caught in that trap.  There are many things you won't know.  Nobody will ever knowing everything (although plenty will try to make you think they do).  So ask when you have a question or look it up.  Remaining ignorant can cost you and your patient, so keep up on your protocols and if you don't know something, don't feel bad about finding out.

Who occasionally flips through his protocol manual?  I do.  Why?  Because the other night we had a patient who fell and struck his head.  He was the perfect candidate for an exam to clear his c-spine in the field.  I turned to our junior crew member and asked, "Do you want to perform and advanced spinal?"

I was met with the blankest stare you could ever ask for.  She said, "I don't know what that is."  So I went through it with her and asked her after the call if she ever read our protocol manual which has an excellent flow chart for the algorithm.  She shook her head and said, "Not completely."

She was presented with the perfect scenario to apply protocol knowledge and she couldn't because she never bothered to learn.  So don't let that be you.  Know your protocols, understand what's expected of you in the most common types of calls you get in your area.

But above all, if you don't know, ask.  None of us were born knowing even though you'd swear some EMTs came into this world driving an ambulance out of their mother's womb.


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## mycrofft (Jul 27, 2011)

*Multiple learning modes*

Some folks are reading learners, some are visual (like demonstrations), some are hands on, some are auditory (lectures) etc. Your protocols will dictate practice at your employer's, as long as they are within the applicable local, state, county, federal, etc etc laws and protocols.


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## Shishkabob (Jul 27, 2011)

"So, do you want us to take you to the hospital?"

That often elicits "Do you think I should go?"'


To which I respond with something that attempts to cover my own butt while attempting to give my medical advice.  blah blah xray, blah blah blood work, blah doctor, blah blah.



(The ones who clearly should be checked out don't get given the option, just 'Let's go get checked out'... ahh wordplay)


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## WuLabsWuTecH (Jul 27, 2011)

What we're taught to say is this (in reply to "Do you think I/my mom/child/etc needs to go?")

When nothing seems wrong:

"Do I think you should go?  I can't make that call, I don't know how you're feeling.  From what we can tell from our assessment and our equipment, everything looks normal, but that doesn't mean it is.  We're not doctors and we don't have the extensive equipment they do in the hospital.  We can only say that from what we can tell you look fine, and if you want to go we can certainly take you if that's what you decide."

When a trip to the ER would be prudent, but not emergent:

"You probably need to go to the ER to get checked out.  Do we _need_ to take you?  From what we can tell, probably not, but we're not doctors and we don't have the extensive equipment they do in the hospital.  We can only say that from what we can tell you look fine to have your husband/mom/etc drive you to the hospital, but if you all are move comfortable with us taking you, we'd be more than glad to do so."


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## Elk Oil (Jul 27, 2011)

I've seen too many instances in which EMTs are a bit too wishy-washy.  If a patient asks me if I think they should go, I'm a step ahead of them saying something like:

"Here's what I'd like to do for you... we're going to put you on some oxygen, take a look at an EKG of your heart and give you some medicine that can help the pain.  So we'll get you to our ambulance and get you going to the hospital.  Sound good?"

So far, the answer has always been "yes."

If it's not an emergency, I'll say something like:

"Since you called and we're here, why don't we take you to checked out?  If it turns out to be nothing, the peace of mind will be worth it.  Whaddya say?"

I usually get a "yes" for these folks, too.

No skin off my nose to take someone to the hospital.  Last I checked, it's what they pay me to do.


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## cruiseforever (Jul 27, 2011)

You call, I haul is my motto.


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## Bullets (Jul 27, 2011)

if its something not serious and there is nothing remarkable upon assessment, ill tell them they will probably get seen quicker by their MD then the ER, but either way i always recommend they go seek advanced medical care. you can come with me or go see your doc.


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## Shishkabob (Jul 27, 2011)

Elk Oil said:


> .
> 
> No skin off my nose to take someone to the hospital.  Last I checked, it's what they pay me to do.



Im sorry - I'm paid to provide emergent care outside of the hospital to hopefully prevent someone dying...not to play taxi to the lazy.

It IS skin off my back to take someone who doesn't need to go because theyre taking potentially life saving resources out of service for upwards of 3 hours...and yes, I have cleared from a call where an ambulance wasn't needed to being literally 30 seconds away from doing a critical life saving intervention.   If we had transported, the next ambulance was 20 minutes away....he would have died without a doubt in my mind.



The sooner we drop the "you call, we haul" mentality...and the supporters of it, the beyer as we can move on to real medicine.  Not everyone that calls needs to go by ambulance.


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## feldy (Jul 27, 2011)

if we dont think they need to go by ambulance...we do the whole...we are more than happy to take you if you want to go but you would probablly be seen quicker if you followed up with your PCP.

If they want to go and really dont need to...we will bring them to the waiting room and we turn into a really expensive taxi cab.


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## Elk Oil (Jul 27, 2011)

Linuss said:


> Im sorry - I'm paid to provide emergent care outside of the hospital to hopefully prevent someone dying...not to play taxi to the lazy.
> 
> It IS skin off my back to take someone who doesn't need to go because theyre taking potentially life saving resources out of service for upwards of 3 hours...and yes, I have cleared from a call where an ambulance wasn't needed to being literally 30 seconds away from doing a critical life saving intervention.   If we had transported, the next ambulance was 20 minutes away....he would have died without a doubt in my mind.
> 
> The sooner we drop the "you call, we haul" mentality...and the supporters of it, the beyer as we can move on to real medicine.  Not everyone that calls needs to go by ambulance.



I agree with a few of your points.  And I think that, to a degree, things like this are grown from the culture of the communities we serve.  We're community-focused and will perform some services like assisting people back into their homes and stuff like that.  We don't do any IFT -- we're only 9-1-1.

When I worked the fast life in the big city, we were much more like what you described.  Out in the sticks, though, we're a "kinder, gentler" service, for lack of a better term.  Nobody on our service is fooling themselves by thinking _everything_ we do is "real medicine," nor is it our goal to drop our current methods because we rely on donations and billing to survive.

Now I know I'm raising some hackles with that last statement.  We are not driven by finances.  We don't needlessly transport patients or "up-code" our billing.  We transport and treat appropriately and we take it as a matter of pride that we play the finances straight.  We don't go to calls looking to drum up business.

But if we have the choice of encouraging the patients to allow us to take them, why wouldn't we?  All other things being equal, we're happy to take someone to the hospital.  Our townsfolk LOVE us, send us donations and thank-you cards with regularity.  This year we also sought a significant increase in our town's budget line because we have to start funding a new ambulance.  Without so much as a murmur, the vote passed unanimously.  And a big part of that is because our community knows we care about them.  Since we only do 250 to 300 calls a year, we're not too worried about overlapping calls.  It's only happened a couple of times in the past two years.


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## Epi-do (Jul 27, 2011)

I have spent plenty of time coming up with ways to say that while someone may need checked out, they don't necessarily need and ambulance or ER to get that accomplished.  Of course, regardless of what I say, it is always prefaced by, "We are more than happy to take you to the ER in the ambulance, however..."  or "We are more than happy to take you, however, honestly, all we can do for X is give you an expensive taxi ride."


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## firetender (Jul 27, 2011)

*We're a service*

...and sometimes we serve best by moving the people to a facility whether WE think it necessary or not. 

The idea of making sure we're available for "real" emergencies is an illusion and perhaps improper definition of our role. The frequency of an IFT for example, significantly interfering with the preservation of someone's life is negligible.

We're there as a first line to serve the medical needs of individuals in our communities, and our job is to get them to the next stage of care. The way our systems are set up, the only options we have to work with are ER's.

That's not our fault, nor is it the fault of the patient.


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## Akulahawk (Jul 27, 2011)

While I'm always happy to transport if that's what the patient wants, I'm not above advising the patient that he or she may be seen quicker by their PCP or at an urgent care than the ED because the ED will triage regardless of how the patient gets there. I won't necessarily _initiate_ the refusal, but I'll suggest alternatives, if I think that an alternative destination is appropriate and in the patient's best interests. Of course I also let the patient know that I can't transport them to that alternate destination though. I have, on occasion, made phone calls to help the patient arrange for self-transport though. 

Sacramento County does have a Paramedic initiated refusal of care... but when I last worked here, that policy hadn't been initiated.


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## mommak90 (Jul 28, 2011)

Linuss said:


> "So, do you want us to take you to the hospital?"
> 
> That often elicits "Do you think I should go?"'
> 
> ...



^^^ Yep!


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## usalsfyre (Jul 28, 2011)

Elk Oil said:


> "Since you called and we're here, why don't we take you to checked out?  If it turns out to be nothing, the peace of mind will be worth it.  Whaddya say?"


The problem is the "peace of mind" really isn't worth a trip to the first/second/third highest cost center (depending on the source) in medicine for something that's going to sit in the waiting room. It's a part of the reason health care premiums continue to rise and there's difficulty funding Medicare. It's really better for everyone, including the patient, from a cost and continuity of care standpoint to refer these folks to their PCP for treatment in the outpatient setting. The "we're not doctors" excuse is a copout, and simply shows we're a)not educated enough and b)unwilling to take responsibility for our actions like professionals.

All that said, we have no mechanism to refer patients elsewhere, so they get transported anyway :angry:.


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## mycrofft (Jul 28, 2011)

*Tongue in cheek answer to the title of this post.*

Vital sign monitor, continuous EKG, NP airway, oxygen, long spineboard and KED, start an IV of SNS TKO, or interosseus if you can't get a vein because the pt is struggling, blanket (to maintain body heat), and an ET tube if they get mouthy.
These are all "just in case".


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## mycrofft (Jul 28, 2011)

*Tongue in cheek answer to the title of this post.*

Vital sign monitor, continuous EKG, NP airway, oxygen, long spineboard and KED, start an IV of SNS TKO, or interosseus if you can't get a vein because the pt is struggling, blanket (to maintain body heat), and an ET tube if they get mouthy.
These are all "just in case".

PS: If appropriate :rofl: alaso apply pads and turn on AED, and break open a field OB delivery pack.


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## WuLabsWuTecH (Jul 28, 2011)

Elk Oil said:


> I've seen too many instances in which EMTs are a bit too wishy-washy.  If a patient asks me if I think they should go, I'm a step ahead of them saying something like:
> 
> "Here's what I'd like to do for you... we're going to put you on some oxygen, take a look at an EKG of your heart and give you some medicine that can help the pain.  So we'll get you to our ambulance and get you going to the hospital.  Sound good?"
> 
> ...





Linuss said:


> Im sorry - I'm paid to provide emergent care outside of the hospital to hopefully prevent someone dying...not to play taxi to the lazy.
> 
> It IS skin off my back to take someone who doesn't need to go because theyre taking potentially life saving resources out of service for upwards of 3 hours...and yes, I have cleared from a call where an ambulance wasn't needed to being literally 30 seconds away from doing a critical life saving intervention.   If we had transported, the next ambulance was 20 minutes away....he would have died without a doubt in my mind.
> 
> ...




Ok, so while I agree with the treat the emergency in front of you and not the emergency you might have later mentality of resource management, what if the emergency in front of you isn't an emergency?  A trip to the hospital takes us out of services for 190 square miles for 2 hours.  If it's not necessary, and we can suggest a better option, why not offer an alternative to our transport.  The transport everyone mentality just doesn't cut it when you don't have that many resources to begin with!

And I agree, they pay you to care for sick people, not to take people to the hospital per se.



Elk Oil said:


> When I worked the fast life in the big city, we were much more like what you described.  Out in the sticks, though, we're a "kinder, gentler" service, for lack of a better term.  Nobody on our service is fooling themselves by thinking _everything_ we do is "real medicine," nor is it our goal to drop our current methods because we rely on donations and billing to survive.
> 
> Now I know I'm raising some hackles with that last statement.  We are not driven by finances.  We don't needlessly transport patients or "up-code" our billing.  We transport and treat appropriately and we take it as a matter of pride that we play the finances straight.  We don't go to calls looking to drum up business.
> 
> But if we have the choice of encouraging the patients to allow us to take them, why wouldn't we?  All other things being equal, we're happy to take someone to the hospital.  Our townsfolk LOVE us, send us donations and thank-you cards with regularity.  This year we also sought a significant increase in our town's budget line because we have to start funding a new ambulance.  Without so much as a murmur, the vote passed unanimously.  And a big part of that is because our community knows we care about them.  Since we only do 250 to 300 calls a year, we're not too worried about overlapping calls.  It's only happened a couple of times in the past two years.



If your resource management allows you to do so, then that point does not apply to you.  But except for a handful of urban areas that have those resources, most areas do not have the resources to transport everyone who needs a taxi ride!!!


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## Elk Oil (Jul 29, 2011)

WuLabsWuTecH said:


> Ok, so while I agree with the treat the emergency in front of you and not the emergency you might have later mentality of resource management, what if the emergency in front of you isn't an emergency?
> 
> But except for a handful of urban areas that have those resources, most areas do not have the resources to transport everyone who needs a taxi ride!!!



This really speaks to a larger and more frustrating part of EMS -- what to do with the patient who wants nothing more than a taxi ride.  Let's face it... MOST of our calls aren't true emergencies.  Yet we transport anyway.

You say that most areas don't have the resources to transport everyone who needs a taxi ride, yet don't we transport people who just want a taxi ride?

The reality of putting the judgement in the hands of EMTs has proven to result in disaster.  People have died because cynical, embittered EMTs haven't transported.  The system isn't going to give that level of subjectivity to EMTs... nor should they.  If each of us doesn't feel a tinge of hesitation by applying a "what if" scenario to a patient we think doesn't need an ambulance, we haven't learned form others' dreadful mistakes.


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## WuLabsWuTecH (Jul 29, 2011)

Elk Oil said:


> This really speaks to a larger and more frustrating part of EMS -- what to do with the patient who wants nothing more than a taxi ride.  Let's face it... MOST of our calls aren't true emergencies.  Yet we transport anyway.
> 
> You say that most areas don't have the resources to transport everyone who needs a taxi ride, yet don't we transport people who just want a taxi ride?



Sometimes we do, but we shouldn't.  If we are really thinking that it is not emergent, we can recommend that they go via POV.  If they insist on going, we'll take them, but often we can say, yeah, that cut will need to be stitched and you should go to the ER, but it's not necessary that we take you though we'll be happy to if you want us to.

This has also led to our neighboring run district no longer soft billing--they send collections on you if you don't pay in hopes that they will reduce the number of taxi-calls.  I think this is awful and the results of the policy are already showing.  We have people from their run district driver either to our station for help, or drive across the county line, pull over to the side of the road, and call 911 then.  Our dispatchers have gotten more than a few callers who have asked: "Which squad will I be getting?" and "Can I get <Insert our name here> instead?" when they are told they can't get us because we only go mutual aid into their county and their squad is available.



> The reality of putting the judgement in the hands of EMTs has proven to result in disaster.  People have died because cynical, embittered EMTs haven't transported.  The system isn't going to give that level of subjectivity to EMTs... nor should they.  If each of us doesn't feel a tinge of hesitation by applying a "what if" scenario to a patient we think doesn't need an ambulance, we haven't learned form others' dreadful mistakes.



Clearly we shouldn't trust EMTs.... <_<

They pay me FOR my judgment.  You should ABSOLUTELY put judgment into the hands of EMTs.  If you can't trust your EMTs to make good judgments, or at least your In Charges to make good judgment, then you need to find new guys to work for you.

And EMTs, many like yourself, wonder why people don't take them seriously!  It's because you don't yourself seriously enough to think you and your judgment can be trusted!


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## JPINFV (Jul 29, 2011)

WuLabsWuTecH said:


> You should ABSOLUTELY put judgment into the hands of EMTs.  If you can't trust your EMTs to make good judgments, or at least your In Charges to make good judgment, then you need to find new guys to work for you.



When dealing with people whose entire medical education is less than 200 hours, how much judgement are they capable of making?


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## Elk Oil (Jul 29, 2011)

WuLabsWuTecH said:


> Sometimes we do, but we shouldn't.  If we are really thinking that it is not emergent, we can recommend that they go via POV.  If they insist on going, we'll take them, but often we can say, yeah, that cut will need to be stitched and you should go to the ER, but it's not necessary that we take you though we'll be happy to if you want us to.
> 
> This has also led to our neighboring run district no longer soft billing--they send collections on you if you don't pay in hopes that they will reduce the number of taxi-calls.  I think this is awful and the results of the policy are already showing.  We have people from their run district driver either to our station for help, or drive across the county line, pull over to the side of the road, and call 911 then.  Our dispatchers have gotten more than a few callers who have asked: "Which squad will I be getting?" and "Can I get <Insert our name here> instead?" when they are told they can't get us because we only go mutual aid into their county and their squad is available.
> 
> ...



It's not that I don't agree with the essence of what you're saying, it's just that none of us can deny that not all EMTs posses the aptitude or are trustworthy enough to make a proper judgement call.  And yes, CLEARLY there ARE EMTs we shouldn't trust.  Do you believe we should blindly trust ALL EMTs simply because they passed their 120 hour course?

Unless we can guarantee ALL EMTs meet some competency level for making those judgements at the moment they are on scene, we should err on the side of caution -- which is what the system does.

Many EMTs HAVE shown they can't be trusted.  Has your head been buried in the sand, or are you just looking at the world through rose-colored glasses?


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## MrBrown (Jul 29, 2011)

If there is no other realistic option available to them then they are usually transported

If their concern is petty or realistically able to be better handed by their GP or the A&M clinic or w/e then no we can refuse transport


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## Shishkabob (Jul 29, 2011)

Elk Oil said:


> what to do with the patient who wants nothing more than a taxi ride.



Easy:  Tell them to call a taxi, as we are not taxis, and they called the wrong number, then we leave.


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## Elk Oil (Jul 29, 2011)

Linuss said:


> Easy:  Tell them to call a taxi, as we are not taxis, and they called the wrong number, then we leave.



Personally, I wold welcome that.  But to my earlier point, patients have died because EMTs made wrong calls; they misjudged and underestimated, or they tried to diagnose and failed.

Look, we can banter back and forth all we like about what should be, but we're faced with what is.  Would I like all EMTs be trustworthy?  Of course!  Would I like all EMTs to posses the medical expertise to make sound judgement?  You bet!  Will we ever get to this point?  Nope!  

And my outlook has no bearing on what will or will not be accomplished.  We must operate within the limits of our protocols that are imposed on us.  Any subjectivity or judgement is granted us in those protocols.

And I'll promise this:  There isn't an employer in the world that won't drop any of us like a hot potato if they get sued because we were negligent and jeopardized a patient.


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## Shishkabob (Jul 29, 2011)

Elk Oil said:


> Personally, I wold welcome that.  But to my earlier point, patients have died because EMTs made wrong calls; they misjudged and underestimated, or they tried to diagnose and failed.



Patients have died from doctors making the wrong call too.  It's the nature of the beast when dealing with human health.



If we're able to RSI.  If we're able to make STEMI notifications solely off our assessment.  If we're able to do ALL the advanced things that Paramedics do... why can we not tell someone with a laceration to the finger that "No, you do NOT need an ambulance, you need your family member standing right here to take you to an urgent care clinic in the car that they drove to the end of the driveway to meet us in"

It makes no sense.


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## WuLabsWuTecH (Jul 29, 2011)

JPINFV said:


> When dealing with people whose entire medical education is less than 200 hours, how much judgement are they capable of making?



When they have been in the field and have thousands more hours of real education and their Medical Directors get to know them, then yeah, I think they are capable of making that call.  I don't care about the 2016 hours of education the guys next to me in my medical school class has, I would trust some of the guys I work with over any of them for me or my family in a heartbeat.



Elk Oil said:


> It's not that I don't agree with the essence of what you're saying, it's just that none of us can deny that not all EMTs posses the aptitude or are trustworthy enough to make a proper judgement call.  And yes, CLEARLY there ARE EMTs we shouldn't trust.  Do you believe we should blindly trust ALL EMTs simply because they passed their 120 hour course?
> 
> Unless we can guarantee ALL EMTs meet some competency level for making those judgements at the moment they are on scene, we should err on the side of caution -- which is what the system does.
> 
> Many EMTs HAVE shown they can't be trusted.  Has your head been buried in the sand, or are you just looking at the world through rose-colored glasses?



I think you're still living in a black and white world where evrything has to be black or white.  Why do we need to guarantee that "ALL EMTs meet some competency level for making those judgements at the moment they are on scene"?  Protocols are written such that the MD knows who he trusts to make judgments.  There are some volunteers on our department that I would trust with little more than driving us to the hospital.  But not all of us are qualified to run as in-charge.  Only the in-charge can make certain decisions and even then different people can have slightly different scopes.  We are getting RSI soon and the MD has straight up told us: this is a skill that some of you will be allowed to have once I have seen your competency and I can trust you.  Some of you might never get to use this skill just on the fact that I don't know you well enough.

My head is neither in the sand nor do my glasses need to be cleaned, I just understand that you don't have to treat all EMTs equally.


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## WuLabsWuTecH (Jul 29, 2011)

Elk Oil said:


> Personally, I wold welcome that.  But to my earlier point, patients have died because EMTs made wrong calls; they misjudged and underestimated, or they tried to diagnose and failed.
> 
> Look, we can banter back and forth all we like about what should be, but we're faced with what is.  Would I like all EMTs be trustworthy?  Of course!  Would I like all EMTs to posses the medical expertise to make sound judgement?  You bet!  Will we ever get to this point?  Nope!



Patients have also died because doctors made the wrong calls.  And they have tens of thousands of hours of training if not hundreds of thousands.  Maybe we should not let them make decisions either?

We will never get to the point of all EMTs being able to have the same set of ideal judgment skills, but why not let those who have it use it rather than blindly following a policy where you agree can strain some of our resources!?


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## Elk Oil (Jul 29, 2011)

Linuss said:


> Patients have died from doctors making the wrong call too.  It's the nature of the beast when dealing with human health. (1)
> 
> 
> 
> ...



1.  Doctors can make decisions that result in death and it's okay.  Doing so is part of their job -- NOT ours.  It's only not okay if they're reckless or negligent.  This is because unlike any EMT, doctors engage in health care RESEARCH, trying new methods and techniques.  Doctors try to find treatments and cures.  EMTs do not.  They take risks and try new things that EMTs shouldn't do.  Take the recent litigation in NYC in which two medics were sued for delivering a baby by C-Section.  Their defense was that they did it under medical direction.  How THAT work out for them?

2.  WE aren't.  YOU are.  Knowingly overstating the obvious, medics have much more training than other certification levels.  It's too difficult when your a state EMS bureau to make the delineations between certification levels with regards to expressing the kind of subjectivity you're talking about.



WuLabsWuTecH said:


> Patients have also died because doctors made the wrong calls.  And they have tens of thousands of hours of training if not hundreds of thousands.  Maybe we should not let them make decisions either?
> 
> We will never get to the point of all EMTs being able to have the same set of ideal judgment skills, but why not let those who have it use it rather than blindly following a policy where you agree can strain some of our resources!?



Because there is no feasible way to separate those who have the ability to express the kind of judgement you're talking about and those who don't unless you limit it to certain certification levels.  But even that's not feasible.

Honestly, I can't believe I have to explain this stuff.  You guys insist on being frustrated by what should be, yet is not.  Embrace what is and make the most of it.  If you want to move things closer to what you believe they should be, get involved with your state's protocol committee or medical control board.  Otherwise, you're just whistling in the wind.


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## JPINFV (Jul 29, 2011)

Elk Oil said:


> 1.  Doctors can make decisions that result in death and it's okay.  Doing so is part of their job -- NOT ours.



Then every drug that can be misused in a way to cause death should be removed from the ambulance. Any use of independent judgement should also be removed from EMS protocols and EMS providers need to stop whining about being considered a profession because they obviously aren't under this situation (lack of independent judgement). 




> It's only not okay if they're reckless or negligent.  This is because unlike any EMT, doctors engage in health care RESEARCH, trying new methods and techniques.  Doctors try to find treatments and cures.  EMTs do not.  They take risks and try new things that EMTs shouldn't do.


...and it's a wonder why there is as much prehospital literature as there currently is. 



> Take the recent litigation in NYC in which two medics were sued for delivering a baby by C-Section.  Their defense was that they did it under medical direction.  How THAT work out for them?


Research!=unilaterally increasing one's scope of practice?


----------



## abckidsmom (Jul 29, 2011)

JPINFV said:


> Then every drug that can be misused in a way to cause death should be removed from the ambulance. Any use of independent judgement should also be removed from EMS protocols and EMS providers need to stop whining about being considered a profession because they obviously aren't under this situation (lack of independent judgement).
> 
> 
> 
> ...and it's a wonder why there is as much prehospital literature as there currently is.




This lack of motivation to acheive independent judgement is a severe stressor on EMS.  

That and I think that most providers just don't have the call volume to get really comfortable with their independent judgment before they're 10 years in and laziness is what establishes their habits.


----------



## JPINFV (Jul 29, 2011)

abckidsmom said:


> This lack of motivation to acheive independent judgement is a severe stressor on EMS.



The problem is that the entire reason to increase education is to make providers capable of independent judgement, and without the ability to use independent judgement (which is not the same as acting without a medical director. Just because someone administers an intervention on their own counsel doesn't mean that they aren't following a protocol. It does, however, provide a certain amount of leeway to provide treatments tailored to the individual patient), then EMS can never be a profession. 

Heck, without independent judgement, the only thing that needs to be taught is to follow the cookbook line by line and how to do each procedure.


----------



## abckidsmom (Jul 29, 2011)

JPINFV said:


> The problem is that the entire reason to increase education is to make providers capable of independent judgement, and without the ability to use independent judgement (which is not the same as acting without a medical director. Just because someone administers an intervention on their own counsel doesn't mean that they aren't following a protocol. It does, however, provide a certain amount of leeway to provide treatments tailored to the individual patient), then EMS can never be a profession.
> 
> Heck, without independent judgement, the only thing that needs to be taught is to follow the cookbook line by line and how to do each procedure.




My nephew is just getting started as an EMT-B, and I'm having the hardest time overcoming the stuff he's been taught in class, to teach him how to actually *interact* with people, consider the next step after hearing what they have to say instead of "Uh, chest pain, uh, 15 L NRB, uh..."

I haven't precepted a complteley green EMT in a loooong time.  I knew the class was useless, but I'm just shocked at how useless it is.


----------



## Elk Oil (Jul 29, 2011)

I got a crazy idea...

How 'bout everyone who has been griping about what I've been saying offer up a feasible solution that you can actually implement and see to fruition?  You can't because people who aren't you control the structure of the emergency medical system, our levels of certification and scopes of our practice.  Simply saying what should be does NOTHING to help the cause.  You can become an EMT understanding the scope of what we do, or you can buck it and get frustrated because all of a sudden you know so much more than when you originally got certified.

Read the posts from prospective EMTs on the forum.  Remember what it was like to be new, nervous, wide-eyed and curious?  Now, you've become disillusioned and frustrated because you think your years of experience have somehow turned to wisdom befitting doctors and that for some reason your scope of practice should be expanded because you've been at this for a while.

Big whoop.  We're all still and just EMTs.  If it's not good enough for you the way it is, either get involved so you can actually change it or do something else.


----------



## JPINFV (Jul 29, 2011)

Elk Oil said:


> I got a crazy idea...
> 
> How 'bout everyone who has been griping about what I've been saying offer up a feasible solution that you can actually implement and see to fruition?  You can't because people who aren't you control the structure of the emergency medical system, our levels of certification and scopes of our practice.  Simply saying what should be does NOTHING to help the cause.  You can become an EMT understanding the scope of what we do, or you can buck it and get frustrated because all of a sudden you know so much more than when you originally got certified.



If you can talk, you're in a place to help influence those in position to make changes. Furthermore, there's nothing stopping anybody from working with the state agencies that do make those decisions. There are plenty of career ladders in EMS, just not plenty that keeps people perpetually in the ambulance. 



> Read the posts from prospective EMTs on the forum.  Remember what it was like to be new, nervous, wide-eyed and curious?  Now, you've become disillusioned and frustrated because you think your years of experience have somehow turned to wisdom befitting doctors and that for some reason your scope of practice should be expanded because you've been at this for a while.



First, some of us are becoming doctors. Second, there's nothing wrong with expanding the scope, provided that initial education is also expanded. Just because the system is set up how it currently is doesn't mean that setup is forever set in stone. 



> Big whoop.  We're all still and just EMTs.  If it's not good enough for you the way it is, either get involved so you can actually change it or do something else.


No, we all are not all just EMTs.


----------



## abckidsmom (Jul 29, 2011)

Elk Oil said:


> I got a crazy idea...
> 
> How 'bout everyone who has been griping about what I've been saying offer up a feasible solution that you can actually implement and see to fruition? You can't because people who aren't you control the structure of the emergency medical system, our levels of certification and scopes of our practice.  Simply saying what should be does NOTHING to help the cause.



I work in our system to better educate providers on the streets, and in the CME.  I work with our medical director to help with QA.  I can show numbers on how what I do makes a difference.



> You can become an EMT understanding the scope of what we do, or you can buck it and get frustrated because all of a sudden you know so much more than when you originally got certified.
> 
> Read the posts from prospective EMTs on the forum.  Remember what it was like to be new, nervous, wide-eyed and curious?  Now, you've become disillusioned and frustrated because you think your years of experience have somehow turned to wisdom befitting doctors and that for some reason your scope of practice should be expanded because you've been at this for a while.
> 
> Big whoop.  We're all still and just EMTs.  If it's not good enough for you the way it is, either get involved so you can actually change it or do something else.



I'm not just an EMT.  I practice emergency medicine within my scope of practice with the same brain I use for critical care, cardiology, and family practice nursing.  While I'm only using my paramedic certification and not my nursing license, I am bringing a lot more to the table than a patch-factory medic, or a new basic EMT.

I think that if you set the bar too low, and expect people to *always* function with the same knowledge base as they got in class, you're asking too little.  I expect providers to act like newbie EMTs only for the first 6 months to a year.  After that, I want to see them thinking more, considering the implications of their decisions, and making plans that include abstract thought.  It's a tough bill, but doable.


----------



## usalsfyre (Jul 29, 2011)

As long as we have statewide protocols and uninvolved medical directors, what is will continue to be. 

Push for real QA, an involved medical director, guidelines that are able to be written for specific groups of providers and stronger education. Accepting the status quo is failing our patients.


----------



## abckidsmom (Jul 29, 2011)

usalsfyre said:


> As long as we have statewide protocols and uninvolved medical directors, what is will continue to be.
> 
> Push for real QA, an involved medical director, guidelines that are able to be written for specific groups of providers and stronger education. Accepting the status quo is failing our patients.




Statewide protocols are a new concept to me.  We don't have them here.  We do have regional protocols, but agencies have individual medical directors who give providers a little leeway with that.


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## Elk Oil (Jul 29, 2011)

abckidsmom said:


> I work in our system to better educate providers on the streets, and in the CME.  I work with our medical director to help with QA.  I can show numbers on how what I do makes a difference. (1)
> 
> 
> 
> ...



1.  Good on you.  We need more people like you.

2.  Yes, but if your system is anything like mine, when you're working as an EMT, you're restricted to that scope of practice.  If you pull out a nurse or doctor level of expertise, you're no longer acting as an EMT.

3.  Agreed, but thinking more doesn't give anyone license to work outside of their scope of practice, which is what some are contending when they say we should be deciding whether or not people take our ambulances to the hospital.

I can't be the only one who is content to work within my scope of practice, am I?  I'm learning new things, getting new certifications, taking classes and course all the time.  Yet I don't feel the same frustrations others here do.  Maybe I'm just more serene about it all.  

If I want to be able to do more, I get certified to do so.  If I felt compelled to change our scope of practice, I'd work to get involved with our MCB, protocol committee and the like.


----------



## Shishkabob (Jul 29, 2011)

Elk Oil said:


> 2.  Yes, but if your system is anything like mine, when you're working as an EMT, you're restricted to that scope of practice.  If you pull out a nurse or doctor level of expertise, you're no longer acting as an EMT.



Wait, what?  I'm not allowed to use things I learn outside of Paramedic school because I'm only working as a Paramedic?  I've used knowledge on calls that many a nurse, the supposed "higher" provider, don't even know and questioned what I did until a doctor told them I was right, things I've learned from doctors directly or my own research.


Go ahead and give a benzo and narcotic to a patient and see how much a nurse freaks out about a "Paramedic performing conscious sedation!?!?!"

You can use whatever knowledge you want, so long as what you DO doesn't surpass your scope.  My knowledge might tell me the patient is experiencing a certain disease process, and treat up to my scope... however having said that, there's also leeway.  If I think something must be done to help a patient, all I have to do is explain my reasoning to a doc and chances are I can do what I have to do, even though it's out of my "scope" (which doesn't exist in Texas, BTW)





Any state that has statewide protocols are archaic.  Any legislator and any physician that endorses statewide protocols as a ceiling need to be kicked out of their positions.  Statewide protocols, at the very most, should be a floor, NOT a ceiling.  It needs to establish a minimum consistency of care throughout the state, not a maximum "Tough luck if you need more"


Texas got it right before any other state:  No such thing as state protocols, and the legislature has no say whatsoever in what an EMT or Paramedic can or cannot do.  It is up to the individual agency, and as such, med control, to decide what is and is not a good match for their employees, their agency education, and their QA.

That's why here in Texas, you have agencies that have RSI, beta blockers and heparin for MIs, tPA for strokes, chest tubes, pericardiocentesis, needle and surgical crichs, ultrasound for things such as FAST exams, Paramedic initiated code strokes and code STEMIs that allow straight bypass through the ER, saving precious time.  


(Then you have agencies like Dallas fire, who can't intubate or give narcotic analgesics....because they don't give a damn about education)



PS Elk...  Paramedics are not EMTs.


----------



## WuLabsWuTecH (Jul 29, 2011)

Elk Oil said:


> 1.  Doctors can make decisions that result in death and it's okay.  Doing so is part of their job -- NOT ours.  It's only not okay if they're reckless or negligent.  This is because unlike any EMT, doctors engage in health care RESEARCH, trying new methods and techniques.  Doctors try to find treatments and cures.  EMTs do not.  They take risks and try new things that EMTs shouldn't do.  Take the recent litigation in NYC in which two medics were sued for delivering a baby by C-Section.  Their defense was that they did it under medical direction.  How THAT work out for them?



The percentage of doctors that engage in research puts them in the minority.  The number of cases they do trials on in even smaller.  The MAJORITY of their mistakes that result in negative patient outcomes are not from research.  I've been in medical research for the past 3 years, and I would argue that those patients are safer the the rest of the population at large with the amount of checks and rechecks in place!

I think a lot of us are missing the crux of your argument here which I just realized after reading this last post.  Your argument is not that most EMT's _can't_ use good judgment, but rather all EMT's _shouldn't_ be asked to use judgment.  You are claiming that our job should not be to use judgment right?  If so, most of the arguments outlined here are moot because a lot of stopple are arguing that some EMT's can use good judgment.



> Because there is no feasible way to separate those who have the ability to express the kind of judgement you're talking about and those who don't unless you limit it to certain certification levels.  But even that's not feasible.



It's extremely feasible!  Let the medical directors decide as they do now!  I'm telling you that we have certain in charge people who can "turf" someone with whom they think there is nothing wrong!  Their refusals are QC'ed by the medical director and their refusal rate is posted on a chart.

Similarly, at another department, certain in charge people can clear C-spine in the field.  These are generally the guys who have decades of experience.  And they also have the judgment to know when not to use this privileged.  The clearing of c-spine has been on our protocol a year and I'm having trouble remembering the last time I saw it used...





abckidsmom said:


> This lack of motivation to acheive independent judgement is a severe stressor on EMS.
> 
> That and I think that most providers just don't have the call volume to get really comfortable with their independent judgment before they're 10 years in and laziness is what establishes their habits.



Agreed, having good judgment means also knowing when you lack the wherewithal to use your judgment and to defer to others' judgment (aka med control or protocol)


----------



## WuLabsWuTecH (Jul 29, 2011)

Elk Oil said:


> I got a crazy idea...
> 
> How 'bout everyone who has been griping about what I've been saying offer up a feasible solution that you can actually implement and see to fruition?  You can't because people who aren't you control the structure of the emergency medical system, our levels of certification and scopes of our practice.  Simply saying what should be does NOTHING to help the cause.  You can become an EMT understanding the scope of what we do, or you can buck it and get frustrated because all of a sudden you know so much more than when you originally got certified.
> 
> ...



Read the last post I just posted, we have things like that implemented.  It's just a matter of whether you want to try to advance the field or sit on your butt and say it's ok the way it is right now.  Sorry for double posting but you posted while I was still working on my last post!


----------



## Elk Oil (Jul 29, 2011)

Linuss said:


> Wait, what?  I'm not allowed to use things I learn outside of Paramedic school because I'm only working as a Paramedic?
> 
> You can use whatever knowledge you want, so long as what you DO doesn't surpass your scope.



We agree.  I think that's what I've been saying.  Forgive me if I didn't convey it.



Linuss said:


> PS Elk...  Paramedics are not EMTs.



That'll be our little secret.  But I could have sworn that before your "P" is an "EMT."  Last I checked the National Registry (the body that has certified you) says you're an Emergency Medical Technician - Paramedic, but I promise I won't let them know.  In fact, you say it yourself by listing it as your training under your avatar, so don't look.


----------



## JPINFV (Jul 29, 2011)

Elk Oil said:


> 2.  Yes, but if your system is anything like mine, when you're working as an EMT, you're restricted to that scope of practice.  If you pull out a nurse or doctor level of expertise, you're no longer acting as an EMT.


You're limited in assessment tools and interventions available, however there's a lot that you can do with your basic senses to improve your assessment as well as your interpretation of your assessment. 



> 3.  Agreed, but thinking more doesn't give anyone license to work outside of their scope of practice, which is what some are contending when they say we should be deciding whether or not people take our ambulances to the hospital.


Scopes of practice can be changed and adjusted. They aren't static.


----------



## WuLabsWuTecH (Jul 29, 2011)

JPINFV said:


> First, some of us are becoming doctors. Second, there's nothing wrong with expanding the scope, provided that initial education is also expanded. Just because the system is set up how it currently is doesn't mean that setup is forever set in stone.



Correct!  When I work in other states or meet people from other states and tell them I'm a basic but in Ohio I can intubate, people look at me as if I had a second head!  But that is within our scope here!  And we have the initial training for it!

Since I started 3 years ago, we now can do 12 lead EKG transmissions, CPAP, and albuterol to name the changes we encounter most commonly.



JPINFV said:


> No, we all are not all just EMTs.



+1



abckidsmom said:


> I'm not just an EMT.  I practice emergency medicine within my scope of practice with the same brain I use for critical care, cardiology, and family practice nursing.  While I'm only using my paramedic certification and not my nursing license, I am bringing a lot more to the table than a patch-factory medic, or a new basic EMT.






Linuss said:


> Wait, what?  I'm not allowed to use things I learn outside of Paramedic school because I'm only working as a Paramedic?  I've used knowledge on calls that many a nurse, the supposed "higher" provider, don't even know and questioned what I did until a doctor told them I was right, things I've learned from doctors directly or my own research.
> 
> You can use whatever knowledge you want, so long as what you DO doesn't surpass your scope.  My knowledge might tell me the patient is experiencing a certain disease process, and treat up to my scope... however having said that, there's also leeway.  If I think something must be done to help a patient, all I have to do is explain my reasoning to a doc and chances are I can do what I have to do, even though it's out of my "scope" (which doesn't exist in Texas, BTW)
> 
> ...



Thank you guys for not checking your brain at the bay door.  And I like Texas's legislation.  Your medical director knows his people the best and knows what they can learn and are willing to learn.

Also Linuss--in Texas, paramedics are not EMTs, but in most places, they still are.  Not everyone has that fancy paramedic degree you guys got down there!  And while I'm giving you a shout-out, hopefully you guys get some rain this weekend!




usalsfyre said:


> As long as we have statewide protocols and uninvolved medical directors, what is will continue to be.
> 
> Push for real QA, an involved medical director, guidelines that are able to be written for specific groups of providers and stronger education. Accepting the status quo is failing our patients.



+1, that's why we got a new medical director.  When you have drugs listed on your license that are no longer produced, it may be time to get someone a bit more involved...



Elk Oil said:


> 3.  Agreed, but thinking more doesn't give anyone license to work outside of their scope of practice, which is what some are contending when they say we should be deciding whether or not people take our ambulances to the hospital.



I'm slightly confused now.  You said you guys have a statewide protocol, and telling someone they may not need to go is outside of that scope?  So you have to try to convince each and every patient to go in the state?  That's baffling!


----------



## Elk Oil (Jul 29, 2011)

WuLabsWuTecH said:


> I think a lot of us are missing the crux of your argument here which I just realized after reading this last post.  Your argument is not that most EMT's _can't_ use good judgment, but rather all EMT's _shouldn't_ be asked to use judgment.  You are claiming that our job should not be to use judgment right?  If so, most of the arguments outlined here are moot because a lot of stopple are arguing that some EMT's can use good judgment.



I think we're pretty close on this.  My contention is that there have been some nasty historical precedents by people who have shown they can't be trusted to express sound judgement.  That only serves -- in some systems -- to prevent others from being allowed to expand their capabilities within their levels of certification.


----------



## Elk Oil (Jul 29, 2011)

JPINFV said:


> You're limited in assessment tools and interventions available, however there's a lot that you can do with your basic senses to improve your assessment as well as your interpretation of your assessment.
> 
> 
> Scopes of practice can be changed and adjusted. They aren't static.



I agree on all counts.


----------



## WuLabsWuTecH (Jul 29, 2011)

Elk Oil said:


> That'll be our little secret.  But I could have sworn that before your "P" is an "EMT."  Last I checked the National Registry (the body that has certified you) says you're an Emergency Medical Technician - Paramedic, but I promise I won't let them know.  In fact, you say it yourself by listing it as your training under your avatar, so don't look.



He's referring to specifically another level in Texas above EMT-P called "Paramedic."  My friend was trying to get me to accept a job out at her summer camp a couple of years ago since they needed a full time EMT and I was looking up the licensure requirements which is the only way I know this.  I ended up not taking the job since Texas is hot and I had just laded a similarly paying job back here!)


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## WuLabsWuTecH (Jul 29, 2011)

Elk Oil said:


> I think we're pretty close on this.  My contention is that there have been some nasty historical precedents by people who have shown they can't be trusted to express sound judgement.  That only serves -- in some systems -- to prevent others from being allowed to expand their capabilities within their levels of certification.



The problem we run into here is that one bad apple ruins them all...  I think you have to prove to your MD that you can use sound judgment on certain topics for him to let you expand out to fill in what he think you are capable of.  By no means would I advocate for letting every EMT be allowed to advise someone that they might not need the ambulance.  Even though I can do so, as a basic, I know my skills are limited and haven't ever advise someone they don't need to go without a medic present also concurring.


----------



## Shishkabob (Jul 29, 2011)

Elk Oil said:


> That'll be our little secret.  But I could have sworn that before your "P" is an "EMT."  Last I checked the National Registry (the body that has certified you) says you're an Emergency Medical Technician - Paramedic, but I promise I won't let them know.  In fact, you say it yourself by listing it as your training under your avatar, so don't look.



Go back and check the NREMTs newsletters.  The "EMT-Paramedic" is to be known as "Paramedic".  Currently the post-nominals are still "NREMT-P", but when 're-certified' it will then be "NRP" for Nationally Registered Paramedic. 

This is due to the NHTSA taking EMT off of Paramedic.   


It's been decided that Paramedics are no longer to be considered technicians.






WuLabsWuTecH said:


> And while I'm giving you a shout-out, hopefully you guys get some rain this weekend!



It rained while I was riding my motorcycle home from work the other day.  I was not expecting it to rain due to only a 10% chance.... gah.


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## Elk Oil (Jul 29, 2011)

WuLabsWuTecH said:


> The problem we run into here is that one bad apple ruins them all...



Yes!  Precisely.  I wish all systems had the same latitudes to allow certain EMTs the ability to do things others with the same level of certification, but the ones around me aren't so progressive.


----------



## usalsfyre (Jul 29, 2011)

I thought NR had stopped putting "EMT" in front of "P". Let's be honest though. Calling a paramedic an EMT is like calling a chef running a five star kitchen a cook. They may have a little overlapping knowledge, and they both have important jobs, but the knowledge base is clearly not equal.


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## usalsfyre (Jul 29, 2011)

Elk Oil said:


> Yes!  Precisely.  I wish all systems had the same latitudes to allow certain EMTs the ability to do things others with the same level of certification, but the ones around me aren't so progressive.



Because your OMDs or management  are uninvolved or too afraid to think outside the box. Not that unusual unfortunately.


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## usalsfyre (Jul 29, 2011)

Elk Oil said:


> My contention is that there have been some nasty historical precedents by people who have shown they can't be trusted to express sound judgement.


I see your point, but disagree mightily. If they're too unreliable to make a relatively simple judgement of something that clearly doesn't require transport, then why do we trust them with complex decisions like when to take an airway, administer meds that are potentially lethal, when to call for HEMS, ect, ect...

If they suck that bad, reeducate. If they still suck, fire and/or decertify them.


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## Elk Oil (Jul 29, 2011)

Linuss said:


> Go back and check the NREMTs newsletters.  The "EMT-Paramedic" is to be known as "Paramedic".  Currently the post-nominals are still "NREMT-P", but when 're-certified' it will then be "NRP" for Nationally Registered Paramedic.
> 
> This is due to the NHTSA taking EMT off of Paramedic.



I'm aware of what the future holds.  But for the time being, I'm afraid medics still have to mingle with the likes of their fellow EMTs.  I hear that in 2018, the Registry will be replacing the "medic" in Paramedic with "god."


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## usalsfyre (Jul 29, 2011)

Elk Oil said:


> I'm aware of what the future holds.  But for the time being, I'm afraid medics still have to mingle with the likes of their fellow EMTs.  I hear that in 2018, the Registry will be replacing the "medic" in Paramedic with "god."



Why is it that people get so upset when the difference in education that creates a vast knowledge gulf is pointed out? I'm not saying EMTs are not important. They're simply not the same. 

That's it, I'm going to be PO'd until physicians start putting "paramedic" in their name. Paramedic-MD and Paramedic-DO. I mean, they do some of the same stuff I do...


----------



## WuLabsWuTecH (Jul 29, 2011)

Linuss said:


> It rained while I was riding my motorcycle home from work the other day.  I was not expecting it to rain due to only a 10% chance.... gah.



Clearly you should ride your bike across the state and make it rain!



Elk Oil said:


> Yes!  Precisely.  I wish all systems had the same latitudes to allow certain EMTs the ability to do things others with the same level of certification, but the ones around me aren't so progressive.



So you're saying that EMTs should be given some latitude?  Just not in your area?



			
				Elk Oil said:
			
		

> I'm aware of what the future holds. But for the time being, I'm afraid medics still have to mingle with the likes of their fellow EMTs. I hear that in 2018, the Registry will be replacing the "medic" in Paramedic with "god."



Well if he can get it to rain, we might call him god for the next few months...


----------



## abckidsmom (Jul 29, 2011)

Elk Oil said:


> I'm aware of what the future holds.  But for the time being, I'm afraid medics still have to mingle with the likes of their fellow EMTs.  I hear that in 2018, the Registry will be replacing the "medic" in Paramedic with "god."



Oh gimme a break.  It's not like that at all, and you're just showing yourself here.


----------



## Shishkabob (Jul 29, 2011)

Elk Oil said:


> I'm aware of what the future holds.  But for the time being, I'm afraid medics still have to mingle with the likes of their fellow EMTs.  I hear that in 2018, the Registry will be replacing the "medic" in Paramedic with "god."



Because it's so bad to want your proper title used :glare:

I had a partner who scoffed at people who wrote "NREMT-B" "NREMT-I(##)" or "NREMT-P" on forms.  Sorry, I earned the title, I'm going to use it... and use the proper one.


I don't see people freaking out if an RN states that they are an RN and not an LVN or CNA... why does a Paramedic get labeled as a Paragod for doing the same?  It's a proper title, just like PhD, MD, DO, OD, PA, NP, RN, etc etc.


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## WuLabsWuTecH (Jul 29, 2011)

Linuss said:


> Because it's so bad to want your proper title used :glare:
> 
> I had a partner who scoffed at people who wrote "NREMT-B" "NREMT-I(##)" or "NREMT-P" on forms.  Sorry, I earned the title, I'm going to use it... and use the proper one.
> 
> ...


It's gonna take me 4 years and $250,000 to earn that M and D after my name and dammit! I'm going to use them!


----------



## Shishkabob (Jul 29, 2011)

WuLabsWuTecH said:


> It's gonna take me 4 years and $250,000 to earn that M and D after my name and dammit! I'm going to use them!



What do you think you are, a physigod or something?!  Psh, you'll probably put "Dr." in front too, huh?


----------



## JPINFV (Jul 29, 2011)

Elk Oil said:


> I'm aware of what the future holds.  But for the time being, I'm afraid medics still have to mingle with the likes of their fellow EMTs.  I hear that in 2018, the Registry will be replacing the "medic" in Paramedic with "god."


I always find it funny when EMTs play the entire, "but but but historically it's been EMT-Paramedic. Hence you're an EMT too and the same as us" card. It's like a physician assistant saying they're the same as a physician since their title includes the word "physician" or CNAs getting mad at LVNs who then get mad at RNs who finally get mad at NPs since all of their titles have the word "nurse" in it.


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## JPINFV (Jul 29, 2011)

WuLabsWuTecH said:


> It's gonna take me 4 years and $250,000 to earn that M and D after my name and dammit! I'm going to use them!


Just remember, you can't spell "doctor" without "DO."

Why do I feel so incredibly dirty for using that line all of a sudden?


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## JPINFV (Jul 29, 2011)

Linuss said:


> Because it's so bad to want your proper title used :glare:
> 
> I had a partner who scoffed at people who wrote "NREMT-B" "NREMT-I(##)" or "NREMT-P" on forms.  Sorry, I earned the title, I'm going to use it... and use the proper one.
> 
> ...




When I was working as an EMT near the end of my grad school I'd sign my name, "JPINFV, BS, EMT-B" every once in a while for no better reason than I could.


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## Elk Oil (Jul 29, 2011)

Linuss said:


> Because it's so bad to want your proper title used :glare:
> 
> I had a partner who scoffed at people who wrote "NREMT-B" "NREMT-I(##)" or "NREMT-P" on forms.  Sorry, I earned the title, I'm going to use it... and use the proper one.
> 
> ...



Unless I grossly misunderstand, until the changes take effect, the proper title _is_ NREMT-P.  Isn't it?


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## JPINFV (Jul 29, 2011)

Elk Oil said:


> Unless I grossly misunderstand, until the changes take effect, the proper title _is_ NREMT-P.  Isn't it?




For NREMT, however some states, such as California, have already removed the "EMT" part from the paramedic title. So in California, there are no more EMT-Paramedics regardless of NREMT status. On a side note, I can't claim to be an EMT-I anymore either...


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## Elk Oil (Jul 29, 2011)

JPINFV said:


> I always find it funny when EMTs play the entire, "but but but historically it's been EMT-Paramedic. Hence you're an EMT too and the same as us" card. It's like a physician assistant saying they're the same as a physician since their title includes the word "physician" or CNAs getting mad at LVNs who then get mad at RNs who finally get mad at NPs since all of their titles have the word "nurse" in it.



No, but when the title actually _is_ NREMT-[letter], what's funnier, the EMTs who feel put off or the medics who feel all of a sudden they're no longer EMTs?


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## JPINFV (Jul 29, 2011)

Elk Oil said:


> No, but when the title actually _is_ NREMT-[letter], what's funnier, the EMTs who feel put off or the medics who feel all of a sudden they're no longer EMTs?


No more funnier than the EMTs who conveniently forget that there's a "basic" in their title.


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## Shishkabob (Jul 29, 2011)

Elk Oil said:


> No, but when the title actually _is_ NREMT-[letter], what's funnier, the EMTs who feel put off or the medics who feel all of a sudden they're no longer EMTs?



The post-nominals are NREMT-P for members of the National Registry.  The title is Paramedic.


The post-nominals are PhD, but the title is Doctor.

Post-nominals are RN, but title is Registered Nurse.


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## Elk Oil (Jul 29, 2011)

JPINFV said:


> No more funnier than the EMTs who conveniently forget that there's a "basic" in their title.



Agreed.


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## usalsfyre (Jul 29, 2011)

Elk Oil said:


> No, but when the title actually _is_ NREMT-[letter], what's funnier, the EMTs who feel put off or the medics who feel all of a sudden they're no longer EMTs?



Has a paramedic EVER been equivalent to an EMT? 

I haven't really thought of myself as an EMT in years...


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## Handsome Robb (Jul 29, 2011)

:nosoupfortroll:

If you want to be a paramedic, sack up, go to school and earn it. All paramedics were EMTs *at one point* they are no longer an EMT though.
Can we be done here please?


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## Elk Oil (Jul 29, 2011)

usalsfyre said:


> Has a paramedic EVER been equivalent to an EMT?
> 
> I haven't really thought of myself as an EMT in years...



I wasn't trying to say that there's an equivalence when each level of EMT certification has very different training and skills.  Like a cardiologist, dermatologist and neurosurgeon are all physicians, Basics, Intermediates and Paramedics are all EMTs.

But to Linuss' point, that's all changing, so it'll be a moot point in the near future.


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## Handsome Robb (Jul 29, 2011)

It already did change if I understand correctly. It changes when you recert. NREMT-P is old news.


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## usalsfyre (Jul 29, 2011)

Elk Oil said:


> I wasn't trying to say that there's an equivalence when each level of EMT certification has very different training and skills.  Like a cardiologist, dermatologist and neurosurgeon are all physicians, Basics, Intermediates and Paramedics are all EMTs.
> 
> But to Linuss' point, that's all changing, so it'll be a moot point in the near future.



But they all have the same initial education and background, then specialize from there. That can't be said of EMT vs Paramedic. Other than "ambulance" there's not much that's the same other than the increasingly ridiculous requirement that paramedics pass an EMT course first.


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## WuLabsWuTecH (Jul 30, 2011)

Linuss said:


> What do you think you are, a physigod or something?!  Psh, you'll probably put "Dr." in front too, huh?



I prefer Doctogod thank you very much!

An aside: apparently it's incorrect to use a title AND post-nominal letters.



JPINFV said:


> Just remember, you can't spell "doctor" without "DO."
> 
> Why do I feel so incredibly dirty for using that line all of a sudden?



if M.D. stands for Medical Doctor, or more correctly, Medicinae Doctor, is D.O. latin for "Other Doctor?"


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## WuLabsWuTecH (Jul 30, 2011)

JPINFV said:


> For NREMT, however some states, such as California, have already removed the "EMT" part from the paramedic title. So in California, there are no more EMT-Paramedics regardless of NREMT status. On a side note, I can't claim to be an EMT-I anymore either...





JPINFV said:


> No more funnier than the EMTs who conveniently forget that there's a "basic" in their title.



Yeah, i wish we'd get rid of the EMT-B, -I, -P system sooner rather than later.

For patients that don't know what's going on: Basic? Where's the guy who knows more than you?  Or, B?  Where's the A EMT?

None of my departments use titles on shirts anymore, but in the privates it certainly did get confusing for some patents who thought they were getting inferior care...


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## MrBrown (Jul 30, 2011)

We have national clinical guidelines, nothing wrong with them and we are better for having such consistency.  

Oh, and WTF is Brown going to have to endure being an MBChB in the US? People already look at Brown like Brown has two heads whenever Brown speaks :unsure:


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## WuLabsWuTecH (Jul 30, 2011)

MrBrown said:


> We have national clinical guidelines, nothing wrong with them and we are better for having such consistency.
> 
> Oh, and WTF is Brown going to have to endure being an MBChB in the US? People already look at Brown like Brown has two heads whenever Brown speaks :unsure:





> :unsure:



Sure does look like two heads to me!

My latin is not very good but I'm going to take a stab at this:
Medicinae Baccalaureus, Churguriuae Baccalaureus?

I know it's the 6 year degree (or 7 years in some countries) of the old England and Scotland system (yes I said it, old because it's not used in the new world anymore  ) that is used in the commonwealth states with some notable exceptions (canada) and other counties still (Japan comes to mind?) and is similar to the NEOUCOM BSMD degree.

I think a long, long time ago Columbia University used to give out MBBS degrees...


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## Shishkabob (Jul 30, 2011)

MrBrown said:


> We have national clinical guidelines, nothing wrong with them and we are better for having such consistency.
> 
> Oh, and WTF is Brown going to have to endure being an MBChB in the US? People already look at Brown like Brown has two heads whenever Brown speaks :unsure:



FYI Brown... your country is about the size of most US states. 25 US states (50%) also have a greater population than your entire country.   In fact, the metropolitan area I live in has a greater population than your entire country in 10% of the area.   Being "national" is no more impressive than being state-wide.


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## WuLabsWuTecH (Jul 30, 2011)

Linuss said:


> FYI Brown... your country is about the size of most US states. 25 US states (50%) also have a greater population than your entire country.   In fact, the metropolitan area I live in has a greater population than your entire country in 10% of the area.   Being "national" is no more impressive than being state-wide.


Uh Oh...  Uh...Brown?  I think he just called your country _small..._


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## Anjel (Jul 30, 2011)

MrBrown said:


> We have national clinical guidelines, nothing wrong with them and we are better for having such consistency.
> 
> Oh, and WTF is Brown going to have to endure being an MBChB in the US? People already look at Brown like Brown has two heads whenever Brown speaks :unsure:



Idk why all of a sudden you think you are better than all of us. 

You are coming to america. Marrying an awesome american. So you cant think you are that much better.


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## Tigger (Jul 30, 2011)

I see no issues with statewide protocols, assuming (as already mentioned) that they are used as minimums. 

The idea that the protocols could be different region to region is a bit baffling to me, wouldn't it be useful to have universal expectations of care statewide? Wouldn't this also eliminate much of the confusion associated with moving from area to area _instate_ (i.e. California)? If anything, EMS needs less governing bodies if any sort of efficient increase in standards is going to occur.

I guess I am kind of partial to the way things are done in MA, where we have a statewide protocol for each level of provider. If a procedure is not listed in the protocol but a service's medical director feels that his providers are educated in its use and that said procedure will be of a benefit to patient care, he and the agency can request a waiver from OEMS. If the medical director isn't comfortable with his providers performing a certain procedure, I can't imagine he would be strong armed into obtaining a waiver, it is his license/reputation on the line as well.


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## JPINFV (Jul 30, 2011)

Anjel1030 said:


> Idk why all of a sudden you think you are better than all of us.
> 
> You are coming to america. Marrying an awesome american. So you cant think you are that much better.




I take the tone of a lot of what Brown says with a grain of salt.


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## abckidsmom (Jul 30, 2011)

JPINFV said:


> I take the tone of a lot of what Brown says with a grain of salt.



Just a small grain of salt.


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## exodus (Jul 30, 2011)

Yummy Crystaloids.


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## JPINFV (Jul 30, 2011)

abckidsmom said:


> Just a small grain of salt.




Perspective. Is that a large grain of salt, or a small grain zoomed in on?


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## WuLabsWuTecH (Jul 30, 2011)

Oh man, this is getting deep...


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## DrParasite (Jul 31, 2011)

tsuna51 said:


> If you get called for something like a stubbed toe, what would you do and say to the patient? Would you just tell them that there is nothing you can do for it and still offer a ride to the hospital/make them sign an AMA if they don't want to? I was just wondering because my teacher said something about how if they call you then you should always offer a ride to the hospital.


yep, pretty much.  sometimes walk the patient to the ambulance, sit on the bench, and we will leave you in the triage area of the ER.  it's actually acceptable and written in policy for ambulatory patients.


Anjel1030 said:


> Idk why all of a sudden you think you are better than all of us.


all of a sudden????? he has been that way since he first popped up on emtlife, what makes you think this is a sudden change?


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## MrBrown (Jul 31, 2011)

Linuss said:


> FYI Brown... your country is about the size of most US states. 25 US states (50%) also have a greater population than your entire country.



And yet that has no bearing on anything whatsoever, Brown notices the US always uses the line of "oh but we are so big" as an excuse.  Sure, 50 autonomous states who are guaranteed the right to self govern when it comes to matters outside Federal jurisdiction and the Constitution makes things more complex ... but lots of other sectors have done it including the Fire Service (NFPA) and nursing. Ambulance Service New South Wales is one of the largest geographic areas of the world for Ambulance cover and it has consistent clinical guidelines, as does British Columbia so sorry mate, being big ain't a good reason.



WuLabsWuTecH said:


> Uh Oh...  Uh...Brown?  I think he just called your country _small..._



Eh, Brown can live with it



DrParasite said:


> all of a sudden????? he has been that way since he first popped up on emtlife, what makes you think this is a sudden change?



Wrong .... Brown is one of the most humble people you could ever meet, just ask Mrs Brown 



WuLabsWuTecH said:


> My latin is not very good but I'm going to take a stab at this:
> Medicinae Baccalaureus, Churguriuae Baccalaureus?
> .



Good job mate, and its five years.



Anjel1030 said:


> Idk why all of a sudden you think you are better than all of us.



We are not better than you, but does it not make logical sense that any jurisdiction who can offer one standard of patient care has an advantage over another who cannot?

Some states like Pennsylvania and Massachusetts have state-wide standing orders, some places like Los Angeles, Miami-Dade and Lee (FL) have County wide standing orders, others like Dallas-Ft Worth (BioTel) and Houston have system wide standing orders unique to that particular area independant of City or County boundaries (ironically Dallas Fire and Houston Fire are two of the absolute worst examples of Paramedic education in the world) while there are hundreds of other services who have standing orders unique to that particular service independent of what anybody else is doing.

A Paramedic in Los Angeles is different than a Paramedic in Reno who is different from a Paramedic in Dallas, who is different from a Paramedic in New York City who is different from a Paramedic in Hot Springs, Arkansas; some are tied to medical control to take a piss and others are not.

Hmm .... could this perhaps be less effective and efficient than a system say like oh Brown doesn't know ... the UK, Australia, various provinces in Canada and down here where we have one set of standing orders?


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## RealMedic (Jul 31, 2011)

In addition to all the medico/legal issues, sadley, the bottom line in the ambulance transport business, is money. If you get a call whether it's emergent or not, you will transport. That's how ambulance transport companies make money. Especially the tranfers, thats where the $ are at. Even 911 calls for BS will get billed to Pt, state, federal, entities for collection. Like the two-tier systems used mostly out west, where when 911 is called, ya get a county/city fire rescue paramedic unit plus AMR or designated ambulance company that contracts with that city/county. They all charge you, your insurance co., state, federal etc...
If you ever even think about a pt. refusal, there is a huge hassle procedure that discourages that in most places for the very reasons I just listed not withstanding that it could be a serious pt. issue as well better evaluated at a definitive care facility. Whew!
Plus another thing, your going to have to do paper work anyway right? Might as well take em in and cover all the bases. Everyone's happy/wins.


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## WuLabsWuTecH (Aug 1, 2011)

Brown, It's only 5 years where you are?  How does that work?  3 Basic Sciences and 2 Clinical? (Or equivalents thereof since hardly anyone in the states does 2+2 anymore).

Realmedic:

Most of the departments where I am either don't bill, or soft bill only.  The discussion here was not about money (though a valid concern) but about patient safety.  I seriously doubt that toe you stubbed will kill you between here and the hospital, nor will it get any worse between here and the ER such that you need a crew.

On the other hand, there are some seemingly minor injuries that can preclude transportation sitting up in a car from being comfortable or could make it outright painful.  If that is the case, I will offer these patients transportation and try to convince them that transport by our squad will be more comfortable/less painful for them.


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## Shishkabob (Aug 1, 2011)

MrBrown said:


> And yet that has no bearing on anything whatsoever, Brown notices the US always uses the line of "oh but we are so big" as an excuse.



Sorry, it does when you try to go "Oh we can do it nation-wide!" when your nation is smaller in size and population than many US states.

That's like Vatican City going "Hey, we have a 30 second response to ANY call for emergency in our tiny 0.2 sq mi country, why can't YOU do it?!"





> Ambulance Service New South Wales is one of the largest geographic areas of the world for Ambulance cover and it has consistent clinical guidelines, as does British Columbia so sorry mate, being big ain't a good reason.



And each of those are consistent with states, not countries.


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## WuLabsWuTecH (Aug 1, 2011)

Linuss said:


> Sorry, it does when you try to go "Oh we can do it nation-wide!" when your nation is smaller in size and population than many US states.
> 
> That's like Vatican City going "Hey, we have a 30 second response to ANY call for emergency in our tiny 0.2 sq mi country, why can't YOU do it?!"



And it only takes them 30 seconds because they stop to pray first!



> And each of those are consistent with states, not countries.



I think what Brown is trying to say is that interoperability would be easier with a nationwide protocol.  The districts he mentions are large yet they have a standard protocol.  Yet we have now come full circle.  If we use a cookie cutter protocol, doesn't that just mean we can't micromanage to let certain people use their own judgment in whether or not to advise for going to the ER POV?


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## Anjel (Aug 1, 2011)

But what works in BFE doesnt in NYC. 

People where linuss is have long transport times somedays. He might have a pt that needs RSI. So he has a RSI protocol. 

Here I have no more than a ten minute trip to a hospital from wherever I am going L&S. We dont have or maybe dont need a RSI order. 

America is huge and vastly different. So the amount of care given prehospital is different.


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## Shishkabob (Aug 1, 2011)

I have NO issue with there being a state- or nation-wide MINIMUM "protocol", where everyone in the state/country can do, say Adenosine 6/12/12 for SVT without consultation of 'med control', etc etc...

But when you use state defined protocols as the ceiling, and NOT the floor... You screwed up.


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## MrBrown (Aug 1, 2011)

WuLabsWuTecH said:


> Brown, It's only 5 years where you are?  How does that work?



Two years of science and foundation of practice and two years of complex practice, plus one year as a Trainee Intern.  We have structured practical clinical exposure and clinical decision making during all five years.  

Once we graduate after five years we do one or two years as a House Officer (House Surgeon) then apply for Specialist Trainee positions (Registrar) 



Linuss said:


> Sorry, it does when you try to go "Oh we can do it nation-wide!" when your nation is smaller in size and population than many US states.
> .



Well it goes to show size is not everything then eh? 

A nationwide standard is not unrealistic, the Fire Service has done it through the NFPA standards, hospitals do it through the Joint Commission, the various medical specialities set their own through their respective Board or College etc.

Brown however thinks a nationwide standing order is unrealistic given the extreme degree of fragmentation that exists however a national standard is not.  State wide standing order has been implemented in several jurisdictions so it is not unreasonable.

For example a sample standard for asthma might be salbutamol, IM or IV adrenaline, hydrocortisone, magnesium etc or a spinal clearance standard or one for RSI.

This however would require a less fragmented approach to education and clinical leadership.



WuLabsWuTecH said:


> If we use a cookie cutter protocol, doesn't that just mean we can't micromanage to let certain people use their own judgment in whether or not to advise for going to the ER POV?



No Brown doesn't think so, plenty of places leave people at home and have a standard set of clinical guidelines such as well here obviously but also Australia (statewide guidelines) and the UK (JRCALC).



Anjel1030 said:


> But what works in BFE doesnt in NYC.



That is very true



Anjel1030 said:


> People where linuss is have long transport times somedays. He might have a pt that needs RSI. So he has a RSI protocol.
> 
> Here I have no more than a ten minute trip to a hospital from wherever I am going L&S. We dont have or maybe dont need a RSI order.
> 
> America is huge and vastly different. So the amount of care given prehospital is different.



Brown has to disagree here.  Here in Auckland our Intensive Care Paramedics have RSI and have had for about the last five or six years.  Some of them are ten minutes down the road from hospital and it has not changed their decision to perform RSI.  You should perhaps reconsider the larger clinical context of being ten minutes down the road from hospital but if your patient needs it, they need it.  

Somebody with traumatic brain injury or refractive status asthmaticus who is about to die infront of you needs RSI the same whether they are ten minutes or ten hours from hospital.

Brown has spent an hour on the floor at Nana's house while we gave her enough analgesia and packaged her so she was comfortable to take to hospital but hospital was only about 12 minutes away if that.  Does that mean we shouldn't have given Nana any analgesia because we were only a few minutes from hospital?


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## Shishkabob (Aug 1, 2011)

MrBrown said:


> A nationwide standard is not unrealistic, the Fire Service has done it through the NFPA standards, hospitals do it through the Joint Commission, the various medical specialities set their own through their respective Board or College etc.?



And neither the JC or NFPA are law stating what can or cannot be done... just recommendations at what should be done.   If a hospital wanted to go against the JCs recommendations, the worst that can happen is less federal reimbursement.

If a Paramedic were to go against protocols, you're facing something from losing your license up to jail time.




The nation-wide protocols are not unrealistic for one thing:  The national scope of practice already states what is expected.  That scope can translate into protocols nationally, and you can expand from there.

Every Paramedic is expected to be able to do a beta agonist for asthma, so that should be a national protocol... however if a certain place wants to add RSI, that's their right.


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## usalsfyre (Aug 1, 2011)

The issue with national and state protocols here would be less if the background of a "paramedic" were the same through out the 50 states. However, currently it varries not only between states, but between freaking regions. I don't want to be held to the same standard as a 10 or 20 week flunkie.


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## WuLabsWuTecH (Aug 1, 2011)

MrBrown said:


> Brown has spent an hour on the floor at Nana's house while we gave her enough analgesia and packaged her so she was comfortable to take to hospital but hospital was only about 12 minutes away if that.  Does that mean we shouldn't have given Nana any analgesia because we were only a few minutes from hospital?



I think here it becomes a time management thing.  RSI takes what? 5 minutes to do including the setup of equipment, starting a line, and getting everything drawn and ready?  Why would you EVER do it when you are 5 minutes to the hospital?  (From our run district, we are never more than 5 minutes to the nearest hospital, usually less).  You should be using that 5 minutes to do other things such as establishing a line, and doing a good initial assessment.  You can have someone bagging for that time without distending the stomach too much right?  And once you get to the hospital where you already have a line established and people standing by to RSI, you can now establish an artificial airway in less than a minute.


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## usalsfyre (Aug 1, 2011)

WuLabsWuTecH said:


> I think here it becomes a time management thing.  RSI takes what? 5 minutes to do including the setup of equipment, starting a line, and getting everything drawn and ready?  Why would you EVER do it when you are 5 minutes to the hospital?  (From our run district, we are never more than 5 minutes to the nearest hospital, usually less).  You should be using that 5 minutes to do other things such as establishing a line, and doing a good initial assessment.  You can have someone bagging for that time without distending the stomach too much right?  And once you get to the hospital where you already have a line established and people standing by to RSI, you can now establish an artificial airway in less than a minute.


I've had the patient that I couldn't move without establishing an airway. The big consideration (for me anyway) in RSI is "is the airway/breathing so unstable that I can't wait until there are more resources and a better situation available".


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## Shishkabob (Aug 1, 2011)

WuLabsWuTecH said:


> I think here it becomes a time management thing.  RSI takes what? 5 minutes to do including the setup of equipment, starting a line, and getting everything drawn and ready?  Why would you EVER do it when you are 5 minutes to the hospital?  (From our run district, we are never more than 5 minutes to the nearest hospital, usually less).  You should be using that 5 minutes to do other things such as establishing a line, and doing a good initial assessment.  You can have someone bagging for that time without distending the stomach too much right?  And once you get to the hospital where you already have a line established and people standing by to RSI, you can now establish an artificial airway in less than a minute.



Honestly, RSI still has it's use even if you're minutes from the hospital.


Who's to say that just because you're 5 minutes from the hospital that you can get the patient there in 5 minutes?  Ever have an obese patient in the absolute back end of a house through a skinny hallway?    I'd be happy if I got them in the sitting position in 5 minutes


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## RealMedic (Aug 1, 2011)

Unless and until you get one standard across the board for EMS, we will always have these issues here in US. It's funny as heck to have the gent from north island give us US EMS folk his code brown opinions when they would fit better in his dr seus hat haw haw a bit of humor just taking a piss mate Right, so no matter what temple ya worship at here NREMT or state, we gotta get one standard educational  and practice to get everyone on the same sheet of music. Unless you have they authority to say no transport (like our UK bretheren) then you will transport that stub toe like it or nor unless you go thru the CPR (conduct  patient refusal) process. Ok next?


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## JPINFV (Aug 1, 2011)

Linuss said:


> And neither the JC or NFPA are law stating what can or cannot be done... just recommendations at what should be done.   If a hospital wanted to go against the JCs recommendations, the worst that can happen is less federal reimbursement.


Alternatively, the hospital can go to a different national or local accreditation service. The Joint Commission isn't the only game in town for hospital accreditation.


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## JPINFV (Aug 1, 2011)

WuLabsWuTecH said:


> I think here it becomes a time management thing.  RSI takes what? 5 minutes to do including the setup of equipment, starting a line, and getting everything drawn and ready?  Why would you EVER do it when you are 5 minutes to the hospital?



So you're 5 minutes from the hospital. However, the time till hospital intubation is going to have the time it takes to package the patient, move the patient from the ambulance to the hospital gurney (including any time it takes to get someone's attention, which is small, but not existent, in an emergnecy), time to give report, time for the physician to examine the patient (also should be short, but not non-existent), and physician to set up for intubation, and then intubate. It's not like you show up at the hospital and an ET tube magically and instantly inserts itself.


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