# Problems in EMS



## daedralarsa (Mar 3, 2008)

ok well for my class we have to identify a problem in ems. however i was just wondering if any of you with years of experience have seen problems in your areas. it can be any problems that you know of locally to nation wide. any ideassss???????


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## skyemt (Mar 3, 2008)

lack of standardization... not only between states, but counties as well...

there are too many different levels, and even at the same level, say basic, emt's can do many different things in different areas...

i think it is confusing to the public.


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## MMiz (Mar 3, 2008)

1.  Lack of qualified personnel
2.  Lack of strong national and local lobbying forces
3.  Traditional view of EMS as transporters instead of treaters.
4.  Lack of funding for EMS, opposed to police and fire.

I hope that helps!


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## Katie (Mar 3, 2008)

Public views of ems are a big issue.  People having such a wide range of expectations.
Standardization is one of the problems in ems.  Universal minimum standards of training like those set out by national registry are a good start.  Stardardized minimum levels with some variation would help as regards to confusion. Standardization is a tricky issue though simply because I think that one size fits all usually ends up fitting no one.  In some areas there really is a need for an emt to be able to do more skills than in an area where hospitals are easily accessible and transport times are short.  Needs differ dastically from place to place.


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## Ridryder911 (Mar 3, 2008)

Actually giving the good points about EMS would be more difficult. 

1. Lack of good education
2. Lack of good education
3. Lack of good education 
4. Lack of EMS instructors that are really educators qualified to teach adult learners
5. Professionalism (lack of) 
6. No career ladder after achieving Paramedic
7. No screening of applicants to enter EMS
8. BLS services are still considered good enough for patient care
9. No incentives to go forward (maybe a time limit on being an Basic) 
10 Did I mention.. Lack of education? 

R/r 911


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## VentMedic (Mar 3, 2008)

There are 48 different certifications and licenses with varying education requirements and various names designating EMS providers in the U.S. 

Education is expressed by the number of "hours" and "skills".

Schools are not always accredited by CoAEMSP and/or CAAHEP.


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## Jon (Mar 6, 2008)

Ridryder911 said:


> Actually giving the good points about EMS would be more difficult.
> 
> 1. Lack of good education
> 2. Lack of good education
> ...


What he said.

PLUS:

Lack of funding
Lack of adequate equipment (vehicles, etc).
EMS playing second fiddle to FD in a "combination" department
Standardization (an EMT should be equal to an EMT anywhere, same for Paramedic)

Hospitals... the lack thereof, as well as Trauma Center problems, etc.


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## Ops Paramedic (Mar 6, 2008)

I can not help you out with topics for local EMS.  There are congnital problems as it seems.

1.  Lack of proper remuniration for our level of education compaired to doctors, as we are specialist in our field
2.  To many "chiefs" and to little "indians"
3.  The authorities who set up the rules and regulations, have no idea as to what is happening on ground level
4.  Bridging the gap between training instutions and industry
5.  Not only the lack of good education, as per rid, but also the lack of certifeid training instutions
6.  Tertiary education vs short courses

There are plenty of identified problems posted on this thread already for, it is up to you highlight a particurlar one (as the opertunity exists) and to action it.


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## JPINFV (Mar 6, 2008)

To add what has been said (especially education), fire service activling fighting against more education.

http://www.iafc.org/associations/4685/files/ems_NtlEMSeduStandardsSectionComments070731.pdf
(bottom of page 3 for their fight against required degrees for paramedics and increase in class hours).


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## firecoins (Mar 6, 2008)

skyemt said:


> i think it is confusing to the public.



I don't think there is much we can do about the general public. Its not something they think about until they need it.

Medical staff also have no idea. As a BLS provider we don't carry pulse oxs and glucometers but nurses and doctors ask me for that info all the time because they get it from ALS providers.


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## el Murpharino (Mar 6, 2008)

firecoins said:


> Medical staff also have no idea.



This is a great point!  We had a patient the other day who we gave dopamine to, and upon arrival at the ER the doctor questioned our use of it without contacting medical control.  We explained to her that dopamine is a standing order for paramedics, after which she promptly and rudely told us to get out.   There was never a question that the patient needed dopamine...

I understand that doctors make the protocols, but not all ER doctors that we interact with don't know our protocols.  As a result, our agency extended an offer for the ER docs to do a ride along with us for a shift.  Not all of them did it, but the ones that did have a much greater appreciation for what we do.  I mean doctors don't have to wade through an inch of filth or extricate a 400 lb. patient down 4 flights of stairs.  Additionally, it has led to much better relations between us and those doctors.


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## EMTIA2-7747 (Mar 7, 2008)

Lack of proper funding has to be on top of the list. Most services here in the north country can't afford to pay EMTs what they are worth. I am a career EMT (over 120Hrs a pay period), and have to hold two other part time jobs to keep afloat. Equipment and supplies cost too much, and insurance companies pay too little. 
We also have a lack of funding for proper training, ie real life like scenarios and seminars.
This, I believe, still stems from the fact that we are yet to be recognized nationally as professionals. The fire service is nationally recognized, the law enforcement service is nationally recognized. we have the NREMT, thats it.


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## Ridryder911 (Mar 7, 2008)

Hmm.. Do we see a trend here? Maybe, *we* are the major problem (source)? 

Really, how much PR education do we really perform? In the case of pay, how much education do we require to demand more pay? How much legislation and requirements we place onto the community to have to have EMS? 

We may ask for it, but doubtfully we want to have to pay the price to stop those problems. Do you participate in associations and organizations for the betterment of EMS? Do you think LEO and FD received such without some work? It just didn't happen. 

Like politics. Unless you participate to change, then one should not complain about it. 

R/r 911


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## firecoins (Mar 7, 2008)

The idea of police and fire department are old. Police deparetments existed in for centuries and fire for almost as long.  EMS is quite new. 

Between EMS and fire there are plenty of EMTs and medics do it for free.  

Fire uses EMS billing to finance fire dept activity.  This pisses me off.


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## AlaskaEMT (Mar 7, 2008)

So we've diagnosed the problems in EMS... how do we resolve them?  

What organizations are fighting for us?  Who is responsible for EMS funding?  (congressman / governor / mayor?)


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## el Murpharino (Mar 7, 2008)

Fire Departments and Law Enforcement have unions and lobbyists who can speak on their behalf.  We don't really have a national-level group or level that inform our elected officials of the perils of EMS.  In fact, I'm not even sure if that is being taken care of at the local level.  EMS is like the stepchild of public service.  It is not regarded as a long-term profession with the long-term benefits of those in the fire service or law enforcement (unless you work for a municipal department, but even then EMS is usually a stepping stone, not a goal).  But on the other hand, fire departments and police agencies are not private agencies that work for profit...


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## Niftymedic911 (Mar 7, 2008)

1. Lack of Education
2. Existence of "Volunteerism" and "EMS based Private enterprise"
3. Lack of Public Relations/ Professionalism
4.TOO Many Cert levels
5. Lack of Funding
6. Fire based EMS oppression
7. No standardization for agency to agency


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## firecoins (Mar 8, 2008)

Niftymedic911 said:


> 2. Existence of "Volunteerism" and "EMS based Private enterprise"


We have an excellent private service providing ALS fly cars Rockland County, NY and work for another providing ALS fly cars in Northern Westchester. But I am biased.  

Two private companies providing service to Yonkers and White Plains, NY privide excellent emts and medics but are poorly managed.  FDNY EMS is also poorly managed in my opinion.  

Private companies do provide an importamt services of interfacility transfers, stand bys at private events and non-emergency calls that would overwhelm 911 systems.  




> 6. Fire based EMS oppression


In general I am against this.  However because ambulance service can be billed, we finance both EMS and fire based operations.  I hate being a tool for fire service who views us as the band aid squad but wouldn't have job without us.  



> 5. Lack of Funding


Cops make a high 5 figure salary in my community. 6 figures with overtime. Any government based EMS system will demand the same for EMS civil serve workers. Community already finances 4 volunteer corps and 2 private ALS fly cars.  It would a tough sell for an independant EMS agency.  If the volley corps fold, the police will most likely take over the service.

FDNY just made EMTs and Medics civil service positions a few months ago.  



> 7. No standardization for agency to agency


Impossible.  Each agency has a different situation. Each region has a different set of protocols.  NY medics have standing orders where NJ medics have to call for medical control.


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## MSDeltaFlt (Mar 8, 2008)

"2. Lack of *strong national and local lobbying forces*"

"1. Lack of good education
2. Lack of good education
3. Lack of good education 
4. Lack of EMS instructors that are really educators qualified to teach adult learners
5. Professionalism (lack of) 
6. No career ladder after achieving Paramedic
7. No screening of applicants to enter EMS
8. BLS services are still considered good enough for patient care
9. No incentives to go forward (maybe a time limit on being an Basic) 
10 Did I mention.. Lack of education? "

If you have strong local and national lobbying forces, the rest should be a little less difficult.


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## firecoins (Mar 8, 2008)

We should study the history of nursing, fire depts and police depts.  See what's good and what's bad.  

Definately need a strong lobbying forces.  We need to get in with ER doctors, trauma surgeons, cardiologists and neurologists.  Between MIs, CVAs and trauma, we are the first line of medical care.  We need to to get them behind us. 

As for adult learning.  I am in a medic class right now.  The head teacher is great but there is much room for improvment.  Many of the instructors, MDs too, really don't know how to teach.  I found that other programs in the area suffer the same problems.


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## Niftymedic911 (Mar 8, 2008)

"However because ambulance service can be billed, we finance both EMS and fire based operations.  I hate being a tool for fire service who views us as the band aid squad but wouldn't have job without us."

Exactly.  Fire based EMS oppression, they use to it fund the rest of their agency, because gee, hey 99.8% of all calls that go through the FD are maybe medical???  It's the red-headed ******* step child of the FD.

Municipal based third service agency that is paid for by taxes.  Hell if FD can tax people for that then why not EMS????  If your town or government was serious about the well being and health of it's citizens, there should be a seperate professional 3rd service EMS agency for your service area.  Or even better a seperate interfacility transfer divison, that takes the load off the 9-1-1 trucks but also secures the budget coming in.


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## Ridryder911 (Mar 8, 2008)

Ironically, this is the "hot topic" in my area, as I described my State Governor has made a proclamation .. "EMS is in Crisis". News stories are a common event. 

The good of this problem is that we have started a coalition and started promoting ideas and brainstorming. I have to admit that IAFF has been helpful with insight and a surprising description that they are ashamed on how much EMS is usually paid. 

Most of the public assume that their EMS services are Paramedic level. I believe that is one of my biggest pit peeves, is with that assumption they do not understand the need of funding. Then as described when the receive the bill, they assume that is the full charge and no additional funding would be needed for EMS. 

What many citizens are not aware of is Fire Departments as well usually bills homeowners for fire services. Usually, they may not receive the bill themselves as it goes to the homeowners insurance claims, unlike medical bills. As well, it is hard to quantify how good we are, when a patient dies. In comparison, when a fire destroys a home we never question, "if better or different" fire attacks or tactics were different, would the outcome be different? Again, public perception is different. 

My today's local newspaper had a photograph of two Firefighters with the Cat in the Hat reading to the children. Oh, what great heroes! Of course no EMS was there. No, they were responding to three times the number of calls than the FD, and alike most other EMT's are either too tired or working another EMS job to make ends meet. 

The other problem is that EMT's are usually ignorant on legislation and the process of government. Compare EMT's to LEO, Firefighters and even other medical professionals to if they belong or participate in an association or group that promotes their profession. Almost every Firefighter I know of are members of some State Fire Association or IAFF. The LEO have the State Peace Officers Association or FOP. The medical associates i.e. Nurses have the ANA or ENA.  The Physicians have the AMA or State Medical Associations. All of these are usually have strong activists along with lobbyist. 

Now in comparison how many EMT's are members of anything associated with a professional association? 

Like I said before, ask a Firefighter whom their representative is and they usually can tell you or have one of their rep's and they can call them on speed dial. Now ask the same question to an EMT and see what they will say?Yet, we do not understand why we do not get the same benefits and recognition ?  

Our State EMS providers are having a meeting at our State Capitol Monday in regards this crisis. I will be meeting with members of the legislature and addressing committees in regards to the alarming numbers. 

An idea that did develop was that  all emergency services personnel that is providing care to the public representing EMS, Fire, Police should be considered as "public safety and service personnel. At first I was skeptical, but the benefits of insurance, protection of laws ( felony charges if assaulted, etc) would be beneficial to all. It would not matter what type of EMS they were. (paid, volunteer, third party, private, hospital based, etc).. just as long as they there representing an recognized agency.

Hopefully, this would also allow for more grants, etc. being recognized as a public safety agency. 

I encourage all EMT's that really do care for EMS, start being active and participating in the "system" process. It is far much more than just taking care of the sick & injured. 

R/r 911


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## firecoins (Mar 9, 2008)

I did a paramedic rotation. The ICU nurse asked about the difference between an EMT-B and a Paramedic.  Medical staff have no clue.

A high school friend of mine met up a couple of years ago.  He just finished med school and was statring a Neurology residency.  He had no idea there were EMT-Bs.  He thought all EMTs were medics.


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## JPINFV (Mar 9, 2008)

Well, to be fair, how often do non-emergency physicians actually interact with EMS? I wonder how many EMTs (B, P, other random letter combinations) know the difference between, say, cardiology and internal medicine.


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## VentMedic (Mar 9, 2008)

firecoins said:


> I did a paramedic rotation. The ICU nurse asked about the difference between an EMT-B and a Paramedic.  Medical staff have no clue.



So you know the difference between LVN, LPN, RN and the different job titles of ICU, OR, ED and Tele RNs?   CNA and PCT?   

Have you called someone with MLT (B.S. and M.S. degreed) a phlebotomist (150 hrs)?  Yes, sometimes the MLT will come out of the lab to "phleb". 

Have you referred to someone taking x-rays an "x-ray tech" instead of Radiology Technologist.  One implies the OJT of yester year and the other is the degreed which is the standard today.

And, there are Radiation Therapists and Nuclear Medicine Technologist who are near the radiology department.  These are very new professions but already have nationally established education and credentialing standards. 

The same can go for Respiratory "Tech" and Respiratory Therapist.  One implies a mimimally educated and possibly OJT from 20 - 30 years ago. Some may still be around but most states and hospitals have expected them to comply with the national standards of a 2 year degree minimum so the profession can progress professionally.  The B.S. (4 yr degree) is also in the making for them as a standard in the near future. 

EMS is almost 40 years old and has not established itself with education and credentialing standards.  It can not longer use the "new" profession excuse.  Those professions that are less then 20 years old mentioned above have moved on and are still moving forward.  

An RN working with any of the above should but doesn't always know what the proper titles are either.  Sometimes they are corrected and sometimes not.  We know that not everyone got the memo on what someone is called in an ever changing world of medicine.   There are other priorities at hand which involve patient care.  Egos can be stroked at more appropriate times.   We identify ourselves to the patients with our titles and a brief description of who we are and what we do.  But, we don't drill them for a quiz later.  There are just too many licensed HCWs to expect everyone to keep all the players, their proper titles, education requirements and job descriptions straight.  

Of course, in our ED when we have paramedic students from the 6 month programs (medic mills) bragging about who they are and what they can do in just a few months of training, they can expect a few "surprised"  looks from professionals who have a minimum of a Bachelors degree.  It is truly amazing some skills can or should be done with only 6 months of training.  A few skills do not always equal education or knowledge.   Occasionally we are refreshed with a paramedic student from the college degree program.  There is a big difference when they already have at least 1 year of college behind them.  We actually have been trying to stop the medic mills from using our facility altogether.  Quality and not quantity would be nicer. As it is now, they are not allowed to practice intubating in our ED or OR. 



firecoins said:


> A high school friend of mine met up a couple of years ago.  He just finished med school and was statring a Neurology residency.  He had no idea there were EMT-Bs.  He thought all EMTs were *medics*.



That is what TV presents and that is what some EMTs represent themselves as when talking to strangers.   We had a lengthy discussion here about the term "medic" not too long ago.  There is even confusion within EMS about the term "medic"
http://www.emtlife.com/showthread.php?t=2753&highlight=medic&page=15


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## reaper (Mar 9, 2008)

Vent,

 You must down around an FMTI school!!! Close them all down!


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## triemal04 (Mar 9, 2008)

Once again, it's same old, same old.  Lot's of people b!tching about the problems (don't get me wrong, there are plenty) and bringing out their axes to grind.  And once again, nobody proposes any real solutions to these problems (with about 1 exception) or is actually doing something to try and fix them (with about 1 exception).  

I'm sorry people, but b!tching and whining is all that you are doing and it's completely unproductive.  If you want to make changes then for f*ck's sake get off your a$$, go out and start trying!  Sitting here and whining is pathetic and accomplishes nothing.

Start talking with those you work with, try and get everyone on the same page there.  Go to the local colleges that teach new paramedics and meet with the instructors.  Start calling your state rep, your mayor, city councilman, newspapers.  Get in contact with the state department of health.  Become actively involved in NAEMT, find out what you can do for them.

If you can recognize the problems that exist, good.  But that's only the first step and it's the easiest.  The hard one is doing something about it.  Will it be easy?  No.  Will you have to make personal sacrifices?  Yes.  Will it be a long process that you may never get any personal rewards from?  Yes.  But if you actually care about this job enough to want it to improve none of that should matter.


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## Niftymedic911 (Mar 9, 2008)

triemal04 said:


> Once again, it's same old, same old.  Lot's of people b!tching about the problems (don't get me wrong, there are plenty) and bringing out their axes to grind.  And once again, nobody proposes any real solutions to these problems (with about 1 exception) or is actually doing something to try and fix them (with about 1 exception).
> 
> I'm sorry people, but b!tching and whining is all that you are doing and it's completely unproductive.  If you want to make changes then for f*ck's sake get off your a$$, go out and start trying!  Sitting here and whining is pathetic and accomplishes nothing.
> 
> ...





Sir,

You obviously missed the post.  The post called to identify problems with EMS.  We're not b****ing on here, we're simply identifying the problems within our area for commonalities.  So, do us all a favor before you fly off the handle, read the post.


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## VentMedic (Mar 9, 2008)

reaper said:


> Vent,
> 
> You must down around an FMTI school!!! Close them all down!



Yeah that one and a few others  as well as FCI  which hasn't changed "endotracheal incubation" on their website.  For the past several months they have gotten emails and phone calls from myself and others but still they have not gotten their web person to correct the spelling.
http://www.floridacareerinstitute.edu/emergency_medical.htm

"Do all this in just a few short months!" 

For those in Florida and elsewhere, "approved" does not always mean "accredited. 

triemal04,
Have you ever noticed that at a state and/or national conference with several thousand EMTs and Paramedics attending, only 20 - 30 show up for the legislative updates?  That is a great time to meet the local reps and lobbyists. Many perceive that part of the seminar as boring or a waste of time or it is just a bunch of suits talking crap.  So, when these representatives see only 20 out of 5000 - 8000 show up, what are they supposed to think about the enthusiasm for the profession?  

And, as some of the Representatives and Senators have stated in the past, "Come back when you can define who you are".  They are correct. When you have 50 states with 48 different titles, certifications and levels of training, all presenting their data at the same time jockeying for position, who knows what we are.   Many would like to funnel more money to EMS, but who, what and where does it go? 

Other professions have a representative speaking with national unity, a national credentialing process with a national education standard and each is recognized by state licensing boards.   

In EMS there is not a strong organization that speaks for EMTs and Paramedics as medical professionals regardless of where they work. The NAEMT is the closest to that and the Flight organiations that have their own agenda but do lobby for advanced scopes.  No union will ever argue for scope of practice.   Nursing realized that long ago and have nursing associations (not unions) to go to bat for them when it concerns their scope of practice. 

Do you want to know how many show up for EMS regional meeting?  Only those that are required from the state and a couple of administrators. 

Too many are so concerned about "skills".  "If they change my title to that I can't do this or that".   There is even a lack of understanding about what education can do for those "skills".  We have more internal battles amongst ourselves than external battles with politicians.


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## triemal04 (Mar 9, 2008)

Niftymedic-  I've read every post here and stand by what I say.  I don't care if you call it b!tching or just recognizing the problems; that part is long done.  Everyone needs to get off their collective lazy a$$ and go do something about it.  (wasn't referencing any particular post either)

Ventmedic-  Thanks for helping to prove my point, I do appreciate that.  (no sarcasm intended)  That is exactly what I'm talking about; a golden opportunity to get something done, or at the minimum try and get the ball rolling, to expose the problems that exist to someone with more power than us and do people take advantage of that?  Nope.  But you can be sure that plenty will b!tch about it at that same convention.  

I know we've gone round and round about unions before, and it's not a arguement I want to have again (not right now anyway  B)) but we both agree that EMS needs an organization that is only about us and fights for us.  Apparently a lot of other people here seem to want that.  So why is nothing being done?

Because talk is cheap.  Now it's time to start standing up for ourselves, or just say screw it, and let EMS die in the US.


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## ffemt8978 (Mar 9, 2008)

Play nice, people


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## Niftymedic911 (Mar 9, 2008)

Then why am I being attacked, but yet your attacking people saying all they do is whine whine whine whine and "nothing" gets done.

If your talking about unions.... mayeb you guys should stem and befriend your local IAFF union.  We're fully represented by the Local 1826 IAFF.  Just like Visa, "Unions, can't leave home without it."


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## Airway Junkie (Mar 10, 2008)

firecoins said:


> I don't think there is much we can do about the general public. Its not something they think about until they need it.
> 
> Medical staff also have no idea. As a BLS provider we don't carry pulse oxs and glucometers but nurses and doctors ask me for that info all the time because they get it from ALS providers.



Wow, what region are you in that you dont carry that?


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## JPINFV (Mar 10, 2008)

Airway Junkie said:


> Wow, what region are you in that you dont carry that?



California, for one, doesn't allow pulse oximetry or glucometers use at the EMT-B level.

Meh, to be honest, there isn't much use either. EMT-B treatment is not going to necessarily change. If the patient has a LOC that is altered from baseline then they should be transporting to an emergency room and/or calling for paramedics. Not screwing around on scene trying to obtain a number that doesn't change their treatment. 

On the other hand, if a system allows providers with 110 hours of training and a few hours of "CEs" to administer medications other than oxygen and oral glucose on their own accord, then I need to make plans to not pass through that area. Yes, if you (generic "you") don't understand why a person needs glucose besides the ambiguous "cell fuel" description thrown out in class, then you shouldn't get to play with the D50 or, god forbid, glucagon. I say "god forbid" because I highly doubt that providers who lack a basic understanding on cellular respiration understand things like gluconeogensis and glycogenolysis. These are things that aren't covered when A/P is limited to 2 hours.


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## skyemt (Mar 10, 2008)

JPINFV said:


> California, for one, doesn't allow pulse oximetry or glucometers use at the EMT-B level.
> 
> Meh, to be honest, there isn't much use either. EMT-B treatment is not going to necessarily change. If the patient has a LOC that is altered from baseline then they should be transporting to an emergency room and/or calling for paramedics. Not screwing around on scene trying to obtain a number that doesn't change their treatment.
> 
> On the other hand, if a system allows providers with 110 hours of training and a few hours of "CEs" to administer medications other than oxygen and oral glucose on their own accord, then I need to make plans to not pass through that area. Yes, if you (generic "you") don't understand why a person needs glucose besides the ambiguous "cell fuel" description thrown out in class, then you shouldn't get to play with the D50 or, god forbid, glucagon. I say "god forbid" because I highly doubt that providers who lack a basic understanding on cellular respiration understand things like gluconeogensis and glycogenolysis. These are things that aren't covered when A/P is limited to 2 hours.



after many disagreements, i am in complete agreement here...

airwayjunkie, i'd love to hear how having those two items will change your treatment as a basic...


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## daedalus (Mar 10, 2008)

Save it guys, this is not a thread about why EMTs should not carry glucometers or oximeters. This is a thread about the problems in EMS. We have discussed the use of these tools many times before. Maybe if EMTs wish to be allowed to use these devices everywhere and have absolutely no controversy over it, we should lobby for better education. I can virtually swear to you all that if EMT was a year program and Paramedic was two years, the whackers, volunteer departments, and idiots will all but disappear. Im not saying any smack on vollies other than, usually, professionals do not offer their services for free, and if EMT took a year, and not a two week camp, many would reconsider getting into EMS. And consider the rise in professionalism...

I recently met a co-worker who went through a two week camp. When a nurse gave him report and told him the Pt was given some ought units of insulin, my coworker said to the nurse: "you mean how milligrams of insulin, right?"

Hmm.....


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## skyemt (Mar 10, 2008)

daedalus said:


> Save it guys, this is not a thread about why EMTs should not carry glucometers or oximeters. This is a thread about the problems in EMS. We have discussed the use of these tools many times before. Maybe if EMTs wish to be allowed to use these devices everywhere and have absolutely no controversy over it, we should lobby for better education. I can virtually swear to you all that if EMT was a year program and Paramedic was two years, the whackers, volunteer departments, and idiots will all but disappear. Im not saying any smack on vollies other than, usually, professionals do not offer their services for free, and if EMT took a year, and not a two week camp, many would reconsider getting into EMS. And consider the rise in professionalism...
> 
> I recently met a co-worker who went through a two week camp. When a nurse gave him report and told him the Pt was given some ought units of insulin, my coworker said to the nurse: "you mean how milligrams of insulin, right?"



guess what... many vollies are paramedic level, and did not attend "two week camps"... and guess what... they are top notch and do work for free...

if your post is another soap box to "bash vollies", please, it's tired and it's all been said before about a billion times. let's not go there...


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## daedalus (Mar 10, 2008)

This isnt a soap box. I am not bashing volunteer EMTs or Paramedics. If EMS wants to be seen as professional, than schooling needs to show it. The paramedic program I am starting in the fall is two years long and when finished I will have a degree in paramedic studies (AA) along with the paramedic certificate. The program will cost me seven thousand dollars and countless hours of studying and probably most of my friends. I have already taken the time to finish the semester long paramedic prep class along with a few college units in pre-recs. After all of this, I do not plan on offering my services for free. So to my knowledge, nowhere in the greater LA area has "volunteer" paramedics. I plan on becoming a PA later on in life, and beyond doctors without borders and clinics serving the uninsured, I have yet to see PAs or MDs running around running "vollie" hospitals.

I respect your views, Skyemt, and I respect volunteers. What I do not respect is the amount of education needed to enter EMS. And it is my personal views that after all the money and time I will spend in Medic school, I want a paycheck.


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## daedalus (Mar 10, 2008)

ill need to pay off my car and student loans


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## Zanerd (Mar 10, 2008)

I have heard some Medics/EMT's discuss volunteering.

Some think its great  and others believe it drags the profession down.  Why pay someone a decent wage (or wage at all?) when there are people out there doing it for free?  

Im not saying volunteering is good/bad or doesnt serve a purpose, its simply a point I found interesting and thought others might too


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## Canoeman (Mar 10, 2008)

Wow -- just read this thread -- looks like the problems in EMS are right here.

There are many problems in our system(s). From care and treatment techniques to how managers can get enough money to pay salaries or get the vols new ambulances. No system can be right or wrong at times. It often is because of the geography we choose live in or the base of our subsities, or progressiveness that are the issues at heart. 
May I suggest, for example, that the EMT with the 110 hour course who has the glucometer and pulse oxymeter near the summit of Mt. Washington can be a very valuable asset to me before I send four of my best Paramedics in lifethreatening harms way to a person with a bit of hypoglycemia that can be easily corrected by the 110 hour guy. I can use that guy from time to time.

Often issues also need to be looked at wearing another persons shoes.


Canoeman


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## JPINFV (Mar 10, 2008)

daedalus said:


> Save it guys, this is not a thread about why EMTs should not carry glucometers or oximeters. This is a thread about the problems in EMS. We have discussed the use of these tools many times before. Maybe if EMTs wish to be allowed to use these devices everywhere and have absolutely no controversy over it, we should lobby for better education. I can virtually swear to you all that if EMT was a year program and Paramedic was two years, the whackers, volunteer departments, and idiots will all but disappear. Im not saying any smack on vollies other than, usually, professionals do not offer their services for free, and if EMT took a year, and not a two week camp, many would reconsider getting into EMS. And consider the rise in professionalism...
> 
> I recently met a co-worker who went through a two week camp. When a nurse gave him report and told him the Pt was given some ought units of insulin, my coworker said to the nurse: "you mean how milligrams of insulin, right?"
> 
> Hmm.....



I agree that education is key. The problem is that a lot of EMT-Bs feel entitled to use what ever shiny, beeping toy (e.g. pulse ox, glucometer, advanced airways, drugs, IVs) they can get their hands on regardless of their (lack of) education. Hence the "I don't get why we can't use [insert toy here] at the EMT-B level" posts that crop up from time to time.

Also, to note about the 2-week camp, EMT-B is a 2 week camp. It's just because some courses drag out the 2 week camp to 3 months by holding classes one day a week doesn't mean that the program is any longer. If EMT-B was academically rigorous, then the course hour time argument would hold less water, but as it stands now it's simply not that rigorous.


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## JPINFV (Mar 11, 2008)

Canoeman said:


> May I suggest, for example, that the EMT with the 110 hour course who has the glucometer and pulse oxymeter near the summit of Mt. Washington can be a very valuable asset to me before I send four of my best Paramedics in lifethreatening harms way to a person with a bit of hypoglycemia that can be easily corrected by the 110 hour guy. I can use that guy from time to time.
> 
> Often issues also need to be looked at wearing another persons shoes.
> 
> ...



Harms way for a medical patient? Being a bit dramatic or do your emergency vehicle drivers need a bit of valium to counteract the adrenalin rush? Why, may I also ask, are EMT-Bs being sent to ALOC calls in the first place? Also, what are the EMT-Bs going to do for the hypoglycemic ALOC patient? Oral glucose is a stop gap, one that can't be used in severely hypoglycemic patients to begin with. Start a line and give D50? Glucagon? Nutritional counseling to prevent more bouts of hypoglycemia from a provider who isn't even required to have taken biochem?


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## daedalus (Mar 11, 2008)

Absolutely correct. It was stated here before by someone, but EMTs are just not educated to view the bigger pictur. I know that EMTs are supposed to be trained to use limited measures to keep the patient alive (AED, O2, CPR, C-Spine) but this is a role that should be left to a non-transporting first responder. Some one in charge of patient care should have a greater understanding of the human body and how medicine works from the nutritional advice given to a diabetic to the complete process of the treatment for AMI right down to discharge.

I learned something in EMT school, I learned that I know nothing. Kinda sucks :sad:


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## AlaskaEMT (Mar 11, 2008)

Interesting USA Today article on this subject:

http://www.usatoday.com/news/nation/ems-day1-cover.htm

Do you think the 3 problems it pinpoints are accurate?


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## Meursault (Mar 11, 2008)

It's USA Today. Therefore, no. The story has some questionable assumptions, and they've dumbed down their coverage of the study so much that I can't really tell how useful it is.

Aside from that, it's heavily focused on DC. Anyone in that area who has an opinion on the story's accuracy?

I have heard good things about Seattle for out-of-hospital arrests: they've been aggressive about bystander CPR and PADs, and from the story, they're apparently doing well with EMS, too. That's great, but completely irrelevant.

I don't think they've identified any of the major problems.
-Turf wars: The author does love to blame firefighters.
-Performance measurement: There are lots of different ways to go about that, some of which are counterproductive.
-Strong leadership: As essentially everyone else has mentioned, the problems in EMS are not regional. Besides, I think the "strong mayor" they're talking about is Tom "Mumbles" Menino. That's made me lose the little sliver of respect I had left.


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