# ACLS/PALS/iTLS VS AMLS/EPC/PHTLS



## d3653je (Sep 18, 2010)

With respect to the above courses, which do you all think is better?


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## Shishkabob (Sep 18, 2010)

Well... ACLS has no equivalent in the other courses you named.



I have ACLS, PALS, and PHTLS.  I'm getting PEPP on Monday.  I'm wanting to get AMLS and NRP some point in the near future. 

No reason why you have to stick with just one agency (AHA vs NAEMT) .  Expand yourself and learn all the alphabet classes.


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## firecoins (Sep 18, 2010)

the best ones are the ones that get you hired and maintain employment.


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## Shishkabob (Sep 18, 2010)

firecoins said:


> the best ones are the ones that get you hired and maintain employment.



Which typically is ACLS, a pediatric course (typically PALS, but many places accept PEPP) and a trauma class, either PHTLS or ITLS.



ITLS is aimed more at intigrating BLS with ALS.  PHTLS is pretty much aimed at ALS providers.


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## rhan101277 (Sep 18, 2010)

I have ACLS, AMLS, PALS, HPBLS, ITLS, ASLS, NRP and GEMS.

The toughest I think was AMLS then ITLS, NRP


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## firecoins (Sep 18, 2010)

I also have CEVO, EVOC, CIA and FBI


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## JPINFV (Sep 18, 2010)

firecoins said:


> I also have CEVO, EVOC, CIA and FBI



Pfft... It's all about Bull S*** More S***, and Dog Ordure.


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## lightsandsirens5 (Sep 19, 2010)

For what?

If I'm having critical cardiac problems, I could really care less if you are ITLS or PHTLS. By the same token, if I have a shotgun blast to the torso or I am pinned under a one ton log, I really don't need you to have an ACLS class under you.


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## socalmedic (Sep 19, 2010)

hmm, i have acls, amls, pals, pepp, and itls. I thought they where all good, they all have their differences, but it was all stuff that I learned in medic school. amls and pepp where similar in structure, one for adult and one for kids. acls and pals where similar, again adult and kids except pals had some medical in it. and i think most trauma courses are the same, maby rural areas with a long transport have a need for more advanced trauma care, but here trauma calls rarely get past the BLS stage before we are pulling into the hospital.


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## Lifeguards For Life (Sep 19, 2010)

lightsandsirens5 said:


> For what?
> 
> If I'm having critical cardiac problems, I could really care less if you are ITLS or PHTLS. By the same token, if I have a shotgun blast to the torso or I am pinned under a one ton log, I really don't need you to have an ACLS class under you.



Yes you do.


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## lightsandsirens5 (Sep 19, 2010)

Lifeguards For Life said:


> Yes you do.



Well, ok. You are right.


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## Jay (Sep 19, 2010)

d3653je, each class is good in its own respect. If you are becoming a medic or are a first responder that has to assist ALS a lot than ACLS and PALS, its pediatric equivalent are right for you. Also, if you do a good number of medical calls (vs. trauma) or like me operate a fly car for first response than AMLS is a good choice because you will get drilled with many different scenarios and twists to see the medical side to dx and treat emergency illness in a way that is presented to really make you think. 

PHTLS is good if you do more trauma than medical where AMLS would be more of a viable option however it is still a good course from what I hear because med/trauma are every EMS providers two core areas.

Some states additionally require EVOC or CEVO and in other states it is nice thing to have though not mandatory. I was also able to have a few dollars of my car insurance because EVOC correlates to "safe driver" with **some** insurance companies but not all.

As for the other courses, if you do a lot of peds calls or simply want it to accompany your PALS than EPC may not be a bad option for you. AHA's PEARS is also a viable equivilant and I myself am hoping to do PEARS within the next month or two, oddly enough peds was one of my weak areas on the state exam though I scored very well overall. It would not hurt to use it as a knowledge boost.

I don't know much about ITLS but there is one other interesting point to bring up, you can always keep going in NIMS, we are required to take ICS-100 & IS-700 but I am in the process of becoming a NIMS instructor and in order to teach NIMS/ICS you may need to get certified at the 200, 300, 400 and/or 800 level as well as have past instructional experience. On the instructors side of certs you can always look into teaching BLS (or ACLS, etc.) and if proficient you will not only be certified but know it inside and out to say the least.


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## Melbourne MICA (Sep 19, 2010)

*Horse for courses*

Are all these credentials/certificates/qualifications/tickets/letters next to peoples names organised and sold by the private sector? 

By way of comparison here in Aussie land there are basically only two levels of qualification in EMS services. BLS and ALS. We call them Paramedics (BLS come intermediate ALS - US EMT-I equivalent) and MICA/intensive care. 

There is no market (allowed) for the private sector companies to spruik courses with a certificate nor University based add-ons to your existing qualifications beyond post grad courses that upgrade you to degree level if you don't already have a B applied science. 

There are now some bridging course developing that link nursing to ambulance partly because a number of our staff come from nursing backgrounds and have recognised qualifications that fast track them through the ambulance course at uni.

Not to seem critical but the US seems awash with people from  private companies flogging off online education courses for EMS. How do your respective services and national representative bodies keep up with accrediting this plethora of "qualifications" from so many different providers.
How do your states and local authorities rationalise standards across so many different curriculum's?

To say it must be incredibly confusing is an understatement.

MM


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## socalmedic (Sep 19, 2010)

confusing kinda, ACLS (advanced cardiac life support) and PALS (pediatric advanced life support) are gennerally required by all agencys and must be renewed every two years. this is because it keeps your knowledge current in these areas as processes and dosages change every few years. these two are only offered from the american heart association. the other courses are sometimes required but not always, some areas they are suggested. these classes would be ITLS (international trauma life support, former BTLS) PHTLS (prehospital trauma life support) ATLS (advanced trauma life support) they are basicly the same but they serve to guide how a trauma call should be handled, by everyone having the same cert everyone on scene should be able to know what is going on. then the last few AMLS (advanced medical life support) and PEPP (pediatric education for the prehospital professional) they both are add on classes that basicly teach you how to think critically about your assessment and  everything you are seeing and how to form differential diagnosis and then eliminate them untill you know what you are dealing with. usualy not required but beneficial to the new medic.

none of them are the same so there is no need to standardize them, and the govt here dosnt give two drops of poop anyway. as long as you have a little piece of paper that says you have taken the class and the date is still current you are good to go. and all the courses listed are 16 hours each, so there isnt much to cover.


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## JPINFV (Sep 19, 2010)

Err... ATLS is definitely NOT the same as ITLS and PHTLS short of it being about trauma. The first is geared towards physicians, the last two are geared towards prehospital providers. In fact, PHTLS was built off of ATLS. It's sorta of like saying that CPR for health care provider and CPR for lay rescuer is essentially the same thing because they both teach CPR, even if the curriculum is vastly different.


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## Melbourne MICA (Sep 19, 2010)

*Confusion indeed*

I guess having EMS in Australia handled by government simplifies things where as the US has such an eclectic model of service providers - private, public, mixed, fire services, hospital services, volunteers etc the standardisation is to offer areas of clinical skills and have your government bodies set minimum standards of qualification (is this via the NREMT and other bodies?) so you can go to an employer and meet their respective hiring criteria. Still what happens when you have a multi-jurisdictional event like a major disaster with mixed patient profiles? - eg, paeds, adult, trauma, medical  all in the one basket? Do the scene commanders shop around amongst the EMS staff to see who has what and can do what? Do you have pissing contest with one bloke saying he has the ITLS another the PHTLS arguing about who should do what?

When you do either the ALS (EMT-I) Paramedic course or the MICA course here all the components are included in the programme. To highlight my point, up until recently the NSW ambulance service had skill sets attached to levels of qualification -so level one qualified, level 2 etc. What happened though was two crews would get to a scene and some had one qualification but not the other, some could put in an IV some couldn't, some had paeds, some didn't or you would get two crews with the same levels but not the skill sets needed for the patient. The system relied heavily on the ALS guys being around who could do everything.

Since you would never be able to predict what was going to be needed at a scene the idea of levels soon went the way of the Dodo. Everybody is trained up to the same level now.

Nonetheless and at the very least, it sounds like somebody out your way needs to simplify things a bit.

Thanks for the info. 

MM


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## medicRob (Sep 19, 2010)

PHTLS was one of the most informative CEU courses I have taken in EMS. I felt like there were some issues touched on in PHTLS that weren't necessarily stressed in EMT school. We went in depth with regard to the kinematics of trauma and deceleration injuries, we spoke about the latest research in fluid rescuscitation, we discussed the rationale behind the Parkland Formula, went over advanced airway assessment techniques such as Mallampatti airway classification, thyromental distance, and even performed face to face intubation, we learned new techniques in moving patients and how to use a sheet as a makeshift C collar and a device to move a patient whenever a c collar or help wasn't available. We discussed the finer points of the ABCDE patient assessment and clinical findings such as Cushing's Triad, Beck's Triad, the significance of JVD, Compensated vs Decompensated shock and symptomology of the 4 stages, etc, covered some of the skills that most of us get rusty on like Thomas Half Ring/Sager, and even covered some of our more advanced skills such as needle decompression and surgical airways. I am fortunate enough to work at the same hospital as the physician who wrote the PHTLS textbook and hosts the podcast. 

I truly came out of this course feeling more confident. 

Also, my certificate makes me feel like an Emergency Mail man.


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## Veneficus (Sep 19, 2010)

I think that the purpose of these classes is misunderstood. 

They are not meant to be difinitive medical education. (Of anykind) They are meant to help keep the skills current for providers who don't frequently use them or to have some sort of credential demonstrating their skills are current. 

They are supposed to be standardized but are not. Many of the instructors of these classes see them as an easy avenue to teach or show off to a certain cohort. Physicians are exceptionally gifted at this. Because the material in the classes is so basic and boring they like to "take it up notch," just so they are interested. Consequently any 2 people could take a class at the same time and have incredibly different information and experience.

If you could truly learn how to take care of patients in a class 16-24 hours long, it would totally eliminate the need for paramedic, nursing, or medical school. In fact you couldn't even read the textbooks telling you what you would need in a month. 

What those classes do teach you is: In the event you observe condition X, you should do Y and if that doesn't help move to Z until an expert can be brought to bear. (either by going to the expert or the expert coming to you)

Many organizations use these classes as requirements because it is a much easier way to demonstrate you are current with your skills than running every person through every competency themselves. 

"Advanced X life support" is a bold faced lie. It is the minimum people who see patients should know. Things like when to unsynchronized cardiovert (shocking, or defibrillation) How to intergrate it in CPR, identifying and intervening in the pediatric periarrest state, not to rapidly infuse gallons of chrystalloid in the trauma patient and take them to an appropriate facility, how and when to deep suction meconium in a new born, etc. 

Incidentally NRP is about the _most _advanced, if you really could call it that, of these merit badge courses, and a majority of what is needed is not even on an EMS truck. "hold on while I put on sterile gloves and create a field for my umbilical vein catheter set up." right? I have had students in these classes not even know what a flow inflating bag was. 

The full title for ATLS is: "ATLS for doctors" and it is designed for nontrauma physicians or ones that see it so infrequently they need to be "refreshed." A paramedc or a nurse tking the class is certainly not going to learn how to read radiology in it. Many places remove or do not let non physicians practice all of the surgical skills. If you learn them in class, you are certainly not authorized to do them. (After you tell med control that you performed a DPL on the rig on your way in to rule in or out a peritoneal bleed, please post it on the forum, see if you can before your license is pulled and don't forget to change your title to add "former") Maybe stop by a thread about getting recertified with a felony conviction too. (not that anyone in the modern world would use a DPL over a FAST or a CT)

Also remember, these classes are based from common emergencies, not all emergencies, and are the recommended baseline to start from, not the definitive treatment there of.

My favorite are the retards that list them as credentials behind their name. like: Joe Shmoe EMT-P, ACLS, PALS, ITLS, NRP, AMLS, GEMS. (you know who you are)


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## MrBrown (Sep 19, 2010)

Veneficus said:


> My favorite are the retards that list them as credentials behind their name. like: Joe Shmoe EMT-P, ACLS, PALS, ITLS, NRP, AMLS, GEMS. (you know who you are)



They makes me laugh .... its like bro seriously


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## Shishkabob (Sep 19, 2010)

Melbourne,


They are continuing education.  Nothing more.  Not "addons" to your cert, and not "proof" that the US way of doing things is dumb/ confusing.


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## 46Young (Sep 19, 2010)

Veneficus said:


> My favorite are the retards that list them as credentials behind their name. like: Joe Shmoe EMT-P, ACLS, PALS, ITLS, NRP, AMLS, GEMS. (you know who you are)



That made me crack up! The joke is, most places require you to have most of these certs just to apply. It's not like you're going above and beyond by getting these, or giving yourself an edge in hiring, or anything.


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## medicRob (Sep 19, 2010)

Veneficus said:


> I think that the purpose of these classes is misunderstood.
> 
> They are not meant to be difinitive medical education. (Of anykind) They are meant to help keep the skills current for providers who don't frequently use them or to have some sort of credential demonstrating their skills are current.
> 
> ...



Somebody needs a hug.


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## firecoins (Sep 19, 2010)

Melbourne MICA said:


> I guess having EMS in Australia handled by government simplifies things where as the US has such an eclectic model of service providers - private, public, mixed, fire services, hospital services, volunteers etc the standardisation is to offer areas of clinical skills and have your government bodies set minimum standards of qualification (is this via the NREMT and other bodies?)
> MM



Standards are set by the Dept of Tran in the federal gov.  otherwise its set but the indivudual states. NREMT is a private company.


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## firecoins (Sep 19, 2010)

Most if not all of the material in these little classes were taught in my paramedic class. Its good to take the classes to refreash all the knowledge I do not use regularly enough.  I don't get excited by having them. The certs just show I completed and understood what we discussed.


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## ERMedic (Sep 19, 2010)

I agree with firecoins. In my medic class we did ACLS, PALS, PEPP, GEMS and PHTLS. Atleast in the Philadelphia area most medic schools will include all of these courses.


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## Melbourne MICA (Sep 19, 2010)

*"Add-ons"*



Linuss said:


> Melbourne,
> 
> 
> They are continuing education.  Nothing more.  Not "addons" to your cert, and not "proof" that the US way of doing things is dumb/ confusing.



I never meant to infer systems in the US were dumb but from an outsiders point of view  you would have to agree it all looks pretty confusing. I appreciate many (most/all?) of these courses are supplements or refreshers. Nonetheless, and correct me if I'm wrong, but:

a) it seems the most of these courses are run outside your service organisations many by the private sector for profit?  - Why is that?

b) most involve getting a certificate of some sort which many here seem willing to include as some sort of new or extra credential on top of their existing qualification.  - How is that allowed to happen and mustn't it confuse people dealing with EMS who don't understand the system?

c) nobody has made it clear whether there are standard additional refresher/supplemental or mandatory programmes for *all* EMS staff in the US. 

Just to look at the pages of this thread as Vennificus pointed there are more letters next to peoples names than you can poke a stick at. And why can't organisations carry out all these programmes with their own tutelage and sign off staff who are up to date under local regional or state based standards requirements? (I am well aware you have state and national standards)

In our system everything is done in house with certain items like RSI, defib etc requiring mandatory periodic re-accreditation. We have a continuing education programme which provides face to face lectures two or three times a year updating knowledge, explaining changes to guidelines etc on top of regular information bulletins, external lecture invitations, group lecture nights and an education department (in which I have worked) that ships out education packages every other week.

I'm just asking questions and making comments to learn a bit more. That's all.

MM


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## MrBrown (Sep 19, 2010)

Most of the courses seem to be aimed at ensuring dexterious use of whatever current psychomotoer skills are trendy rather than application of cognitive knowledge.


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## Veneficus (Sep 19, 2010)

Melbourne MICA said:


> a) it seems the most of these courses are run outside your service organisations many by the private sector for profit?  - Why is that?



Outsourcing. On my time off from school I work for a hospital and part of my job is teaching these classes. The hospital does not charge employees for the classes and they are required for continued employment. So technically they are in house.

However, many smaller organizations cannot afford to have all this done in house. So there creates an opportunity for independant contractors to use the same standard curriculum an service many agenices. Many agencies together can usually make steady work for a small group of individuals. The time and expenses do not always make fiscal sense to have in house.

Many of the organizations these classes come from spend millions of dollars to research, update, and come up with these curriculums. It is beyond the means for independant organizations. Don't forget, the US is a pay to play system. Hospital A makes money by having superior service to Hospital B. Certainly they will not give away trade secrets. 

(I don't agree with the system, but it is what I have to work with)




Melbourne MICA said:


> b) most involve getting a certificate of some sort which many here seem willing to include as some sort of new or extra credential on top of their existing qualification.  - How is that allowed to happen and mustn't it confuse people dealing with EMS who don't understand the system?



The certificates simply state you met the criteria for the class. It is up to the individual agencies to determine their value. None of these classes gives you the authority or right to practice anything you learn in them. It is your primary educational credential that does. So for example if you learn how to do a DPL in ATLS class, then unless you are a qualified physician, you are not permitted to perform one. The same if you were a nurse who learned to intubate, your employer determines your scope. 

As for the extra titles, the only people they impress are nonmedical providers.



Melbourne MICA said:


> c) nobody has made it clear whether there are standard additional refresher/supplemental or mandatory programmes for *all* EMS staff in the US.



Because the US is a federation of states, the individual state decides on the required refresher for the primary credential. The federal government cannot control that. However, many states choose to use the same standards for the purpose of reciprocity between them. MD, DO, RN, PA, Parmedic, EMT, etc. merit badge courses are sometimes required. For example in Ohio, in order to meet the refresher qualification for paramedic you must have a current ACLS card. (to demonstrate you are current with the skills of what is viewed as the primary job of the paramedic) Credentialing agencies will recognize a certain amount of hours for the course for various reasons. So while you may spend 16 hours in an ACLS course. You licensing authority may not recognize all of it or may give you more credit. (usually it is much less)

However,non governmental hospital accrediting agencies, like JCAHO, have a real power to instill their will upon organizations. They are basically recognized as an authority, and the loss of their graces, by not meeting their recommended standards, will cause a facility to not be eligible for federal healthcare monies like medicare and medicade. (which is more than 25% of all payments nationwide) Additionally any healthcare organization not meeting these standards will find that private insurance will not pay for their services either. In short, they are not a government body, they are used by the government as a standard.

It is also one of the reasons EMS tries to firmly plant itself in public safety. A publc safety agency is immune to a considerable amount of standards even outside healthcare. 



Melbourne MICA said:


> Just to look at the pages of this thread as Vennificus pointed there are more letters next to peoples names than you can poke a stick at. And why can't organisations carry out all these programmes with their own tutelage and sign off staff who are up to date under local regional or state based standards requirements? (I am well aware you have state and national standards)



As detailed above, many organizations (hospitals, EMS agencies, etc) cannot afford to have their own educational departments. It is much cheaper to use an already established curriculum than it is to research and create your own. (which on the cheap can run hundreds of thousands of dollars a year when you factor in the salaries of the people doing it)

However, your agency can choose not to recognize some or any of these classes. For example, at my employer, they only recognize BLS, ACLS, and PALS from AHA. they do not recognize any other curriculum from any other agency.

In all fairness, many of these classes are put together to be concise information in order to give healthcare providers what they need to do no harm or at least help a little until an expert can be found.

The trouble is, they are not meant to be definitive education. Many people also like the format so everytime somebody has something new to say, they copy the 2 day "do this until somebody who knows shows." It is impossible to maintain all of them and a new one shows up every year. (Like advanced burn life support)



Melbourne MICA said:


> In our system everything is done in house with certain items like RSI, defib etc requiring mandatory periodic re-accreditation. We have a continuing education programme which provides face to face lectures two or three times a year updating knowledge, explaining changes to guidelines etc on top of regular information bulletins, external lecture invitations, group lecture nights and an education department (in which I have worked) that ships out education packages every other week.



Places that can afford that do. It's all about the money.


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## Shishkabob (Sep 19, 2010)

Melbourne MICA said:


> a) it seems the most of these courses are run outside your service organisations many by the private sector for profit?  - Why is that?



Because people like money?

The PEPP class jimi and I are taking tomorrow is free, and being put on by a pediatric hospital... and we are getting free lunch! (woot!)




> b) most involve getting a certificate of some sort which many here seem willing to include as some sort of new or extra credential on top of their existing qualification.  - How is that allowed to happen and mustn't it confuse people dealing with EMS who don't understand the system?



Who cares if they don't understand why we do the classes beyond knowing it's "continuing education"?

It's essentially continuing ed, and the "certificate" they give is essentially proof that you took and passed the continuing ed class, incase you get audited by your credentialing agency. 




> c) nobody has made it clear whether there are standard additional refresher/supplemental or mandatory programmes for *all* EMS staff in the US.



Every single Paramedic job I've seen requires ACLS.  Most other Paramedic jobs usually wants PALS/PEPP for pediatrics, and PHTLS/ ITLS for trauma, and of course CPR.

EMTs don't require any 'additional" courses aside from CPR.



But those classes only refresh what every Paramedic should already know... and maybe teach something new when new guidelines come out. 





> Just to look at the pages of this thread as Vennificus pointed there are more letters next to peoples names than you can poke a stick at. And why can't organisations carry out all these programmes with their own tutelage and sign off staff who are up to date under local regional or state based standards requirements? (I am well aware you have state and national standards)



Because ACLS and PALS are from the AHA, and PEPP/PHTLS are from NAEMT.  Our agencies, be it fire, private or whatever, don't own the AHA or NAEMT.  The people who teach ACLS/PALS/PEPP/ whatever have to be credentialed by the agency that puts on the class.

You WILL often see some agencies that will put one of their people through the instructor course, for say ACLS or PALS, so that they can teach it inhouse to their employees, for free, and save money.





These classes are just like taking a CPR course... just different letters with a different subject matter.


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## MrBrown (Sep 19, 2010)

Veneficus said:


> So for example if you learn how to do a DPL in ATLS class, then unless you are a qualified physician, you are not permitted to perform one.



Gah! Get a bloody CT machine or nick the ultrasound from OB


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## Veneficus (Sep 19, 2010)

MrBrown said:


> Gah! Get a bloody CT machine or nick the ultrasound from OB



I like to use that example. Everywhere I have been used FAST and CT.

The fact it is still in the ATLS book speaks volumes to how much effort goes into updates. Only in the 8th edition is permissive hypotension even discussed.

I guess if you were out in the Bush it might be a good skill to know. But then so would digging graves because if the DPl is diagnostic and you cut somebody open in the back country, you better have some wicked antibiotics with you too.


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## LucidResq (Sep 19, 2010)

Linuss said:


> Every single Paramedic job I've seen requires ACLS.  Most other Paramedic jobs usually wants PALS/PEPP for pediatrics, and PHTLS/ ITLS for trauma, and of course CPR.
> 
> EMTs don't require any 'additional" courses aside from CPR.



I'm gonna throw a wrench in there... almost every single EMT-B job in CO requires IV and EKG.


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## jjesusfreak01 (Sep 19, 2010)

LucidResq said:


> I'm gonna throw a wrench in there... almost every single EMT-B job in CO requires IV and EKG.



Wouldn't that make them closer to EMT-IV's or EMT-Cs possibly?


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## medicRob (Sep 19, 2010)

jjesusfreak01 said:


> Wouldn't that make them closer to EMT-IV's or EMT-Cs possibly?



Depends, are CO EMT-B trained to i/85 or above? EMT-IV is i/85, not just B with extra IV endorsement.


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## LucidResq (Sep 19, 2010)

jjesusfreak01 said:


> Wouldn't that make them closer to EMT-IV's or EMT-Cs possibly?



The whole IV thing in CO is unique to the state. No, they are not EMT-Is. I've never heard of EMT-Cs. They are their own category for sure. 

The full name for it is "EMT-B with IV authorization." I've seen it abbreviated several ways, such as EMT-B(IV).

They can administer crystalliods (NS, LR, D5W) D50, and Narcan.


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## Melbourne MICA (Sep 20, 2010)

*Questions answered*

Funding and outsourcing. Two pretty common factors no matter where you are. It's an interesting contrast between the EMS agencies here with a heavily weighted government input and the more diverse privatised models in the US. At the end of the day it still comes to do dollars unfortunately.

So to Venny and Linus- thank you boys - questions answered. I appreciate the effort.

MM


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## DrParasite (Sep 20, 2010)

Melbourne MICA said:


> Funding and outsourcing. Two pretty common factors no matter where you are. It's an interesting contrast between the EMS agencies here with a heavily weighted government input and the more diverse privatized models in the US.


it's not the input that causes the disparities 





Melbourne MICA said:


> At the end of the day it still comes to do dollars unfortunately.


Bingo.  in the US, most of the EMS system isn't publicly funded, or rather, isn't 100% publicly funded (EMS gets the left overs when the FD or PD are done pillaging the piggy bank, because they are the b@stard step child that no on wants except to get money).

I have PHTLS, and it's a pretty good course.  PEPP was good too, but I really want to take an ABLS (advanced burn life support) class.  But finding one that will let a lowly 120 hour person in is harder than I thought.  plus they are only offered every other year doesn't help.

DrP EMT, DBP, PHTLS, EMD-I, CPR-I, BS SU '03, 911-I, PEPP, GEMS (I think I have this one), Teamsters Local 97 (I think).

Now that I think about it, I might make that my signature......


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## FFMedic75 (Sep 20, 2010)

I found AMLS to be one of the better classes I have taken.  PEPP is a total waste of time.  PHTLS and ITLS are about the same the curriculum is a little different.


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## sir.shocksalot (Sep 21, 2010)

medicRob said:


> Depends, are CO EMT-B trained to i/85 or above? EMT-IV is i/85, not just B with extra IV endorsement.


CO is apparently weird when it comes to EMT-B's starting IV's, it's pretty much standard that if you are an EMT-B on an ambulance, you can start an IV. It actually is extremely frustrating working with an EMT who can't start an IV because they are new and haven't finished the course yet.
But to answer your question a CO EMT-B IV is just an EMT with an extra day or two long class that can start IV's and administer crystalliods and D50. This is actually extremely helpful on an ALS ambulance, and horrifying if they are doing it on their own.

And as far as courses go I have PHTLS and PEPP aside from the required ACLS and PALS. I want to take ABLS but its like 300 bucks which to me is a little steep at this moment, I will also be taking AMLS and NRP soon so we'll see how useful I find them. I loved PEPP and PHTLS, I found it to me informative, a good review of school stuff and some intro to new research that has come out, but it seems like it could be very instructor dependent.


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## DrParasite (Sep 21, 2010)

sir.shocksalot said:


> But to answer your question a CO EMT-B IV is just an EMT with an extra day or two long class that can start IV's and administer crystalliods and D50. This is actually extremely helpful on an ALS ambulance, and horrifying if they are doing it on their own.


Please explain this statement

if an EMT can check BGL, determine it to be low, and administer D50, without the aid of a medic, how is it horrifying?

or if they are just starting a line, for the sake of making things easier for the ER, again, how is this horrifying?

and how is it very helpful if they do it in the presence of a medic, but doing it on their own is a sin against nature and dangerous to the health and safety of humanity?


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## LucidResq (Sep 21, 2010)

DrParasite said:


> Please explain this statement
> 
> if an EMT can check BGL, determine it to be low, and administer D50, without the aid of a medic, how is it horrifying?
> 
> ...



D50 is not a benign drug. Even if the person is profoundly hypoglycemic, a simple error can turn in to devastating extravasation and necrosis. I'm not arguing for or against it, really, but it's something to consider.


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## 46Young (Sep 21, 2010)

LucidResq said:


> D50 is not a benign drug. Even if the person is profoundly hypoglycemic, a simple error can turn in to devastating extravasation and necrosis. I'm not arguing for or against it, really, but it's something to consider.



As another example, if someone has a suspected stroke there may be a hemhorragic bleed (no way to tell). There are considerations with given D50 to someone with stroke like S/Sx and also a low BGL. This is but one situation to illustrate why it's not appropriate to administer meds without the proper education and diagnostic equipment. At the EMT-B level, the education just isn't there.

All drugs need to be treated as if they have the potential to kill. Even drugs that some perceive to be benign, such as O2, D50 and 0.9% NS. 

For example, hyperventilating a pt with head trauma may drop their CPP to the point that the brain receives no perfusion. In cardiac arrests, what effect does hyperventilation have on coronary perfusion? D50 can extravasate and cause local tissue necrosis. Diabetics are already prone to PVD, so how far will that necrosis spread in the presence of poor perfusion that impedes healing? What about extravasation to the brain if there's a bleed? There's a reason we now have permissive hypotension protocols, both for penetrating and blunt trauma. There's also a reason we reassess L/S after each 500 cc bolus. You may have learned a few things from the medics or possibly a CME or inservice, but that is certainly not a substitution for a paramedeic level education.

I can agree with EMT's starting lines by diection of the medic. Maybe also for certain protocols that specifically allow an IV to be placed only with certain inclusion criteria based on pt presentation, when there are no medics present. IV access is an invasive process, is not without it's complications, and ought to be reserved for pts that really need them. Again, the EMT-B level of education is inappropriate to make this determination.

Edit: "Monkey see, monkey do," aka cookbook medicine has been a bone of contention within the ALS community, let alone BLS. Doing something as simple as starting a line and giving D50 for a pt with a low BGL at the BLS level is an extreme example of that. There's a whole lot more to it than just giving sugar for a low BGL, O2 for the hyperventilating pt, fluid for the hypotension, etc.


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