Call for ALS?

[Veneficus]

Explain "competently trained" as it stands for the 110 hour EMT-B.

Let me add to it.

Explain how in Basic class you learn an abbreviated physical exam and history taking and make a determination on whether or not it is serious without understanding of anatomy,physiology, pathophysiology, histology, and biochemistry?

How could you claim such people were "competently trained?"

Have you ever seen a 70 y/o PE patient scream at you they couldn't breath and fight off 6 firemen? All that stuff about patient airways and chest rise and fall goes right out the window.

In truth I see the need for tiered systems. But until education standards are raised, currently an assessment by a paramedic with some of the background knowledge at a college level is better than the oversimplified version of what is presented in "Emergency Care."

To answer my own question that I posed for debate, ALS is knowledge, not skills or procedures.

 

[boingo]

True, the BLS (ALS too) training is inadequate, but at the end of the day, neither group has much to offer to the PE patient. Unless we are making the dx and giving a thrombolytic, recognizing the problem, notifying the recieving facility and a rapid, safe ride are all that we have to offer.

 

[VentMedic]

True, the BLS (ALS too) training is inadequate, but at the end of the day, neither group has much to offer to the PE patient. Unless we are making the dx and giving a thrombolytic, recognizing the problem, notifying the recieving facility and a rapid, safe ride are all that we have to offer.

A little education could keep someone from dxing a PE as just "hyperventilation" and putting the patient's face in a paper bag. Unfortunately that still happens or the 2 L by NRBM.

So is there even a point to fighting for higher education standards in EMS?

Do many medic mills actually have the right idea as do the FDs (not all) who believe in training and the amount of education as it stands is adequate?

Should we just stop wasting our breath and typing fingers for the education issue?

Should we just focus on the few skills present in EMS now without looking at what could be?

Should we just make the lowest level provider the standard of care or revert to the scoop and run treatment?

EMS has managed to survive somehow for over 40 years at the same level with all the other professions have grown. Maybe it is just meant for EMS to stay at a tech level with the votech style of training.

 

[Ridryder911]

I am seeing the "shaking" of those that are fearing the wrath of having to consider to be accredited. Rumors and rumors of rumors, are occurring. Even the thought of removing from the NREMT and attempting to offset the costs of developing test that would costs hundreds of thousands of dollars instead of placing that money into education and doing things right. Yeah, real thinking there. Again EMS is always full of excuses.

I am not going to give up... I do see a light at the end of tunnel. As the shortage has now became at dangerous levels, if medics proceed to do things right we could advance the profession. Yes, there is going to be opposition. Unfortunately, most of this will come within the profession (EMT's) itself.

In regards to Basic EMT, it is just a little more than first aid. Nothing more. The curriculum is not written well enough to be able to screen nor treat injuries or illnesses more than first aid level. Reviewing the new curriculum, it might be a little better but not much. Again most forget it is nothing more than an entry level. This is similar comparison to a nurse aide to a RN. The good thing is that majority of nurses aide realizes and knows their place within the profession realizing they have little to no medical training.

Is the EMT level warranted? Yes, as a first responder level or for non-emergency transports only.

R/r 911

 

[triemal04]

Honestly!


You are a supposedly a Paramedic who should be just as capable of explaining this also.

You have already tossed your insult with the "full of themselves" remark.
So no, I am not going to waste anymore of my time typing out everything for you. And don't bother PMing me with more of your insults and profanity either. If you had an ounce of credibility or sincerity, I wouldn't mind, but you don't have either.

You're correct, I am. But I am not one of the paramedic's or ex-paramedic's that was asked to explain it, or, replied to the person who asked that without explaining. You are. Instead of, as I said, explaining why knee pn could be indicative of something more serious than say, a torn meniscus, and thus helping someone with less knowledge understand why they should not be so quick to see something as common as knee pn as benign, you choose to go on and on about how medicine is not clear cut (it's absolutely not, I agree completely) and how a basic can't be expected to understand it's complexities. Basically, instead of using what could have been a teachable moment to it's full advantage, you got on your soapbox. Cheers. And don't worry, I'll stay out of this thread from now on. It's pointless. Just like last time...and the time before...and the time before...and the time before that.

Veneficus- thank you. That's what I was hoping for. At least now a basic with their minimal education/training will have a better idea of WHY so many people don't blow of the minor complaints.

 

[triemal04]

Veneficus did list a number of the possible problems that could be indicated by what many a BLS provider would dismiss and sadly so would many diploma mill paramedics.

If BLS only responded nothing really could be provided to help those that rapidly crash. If ALS responded many possible interventions could be started that might get the patient to the hospital with a chance of leaving the hospital alive and basically intact.

DVT, Gullian-Barre sydrome, localized tissue ischemia, osteomalasia, sickle cell crisis, and typhus. Please list out the treatements that will be done by a paramedic vs a basic and how they will benefit the pt. Again, this thread get's repeated time and time again, for once let's make it so people can actually learn something from it. So please, give the treatements so that basic providers will know WHY people are saying that all pt's deserve an ALS assessment.

I swear I'm done now.

 

[boingo]

Vent, I agree that educated providers are needed, and hopefully we will see a minimum of an associates required to work in an ambulance. I'm just saying that the care available really doesn't differ for this particular patient. Recognizing the problem, initiating basic care and transport is what we have to offer. As long as the fire service has their hand in EMS in this country education standards will continue to be piss poor. I am all in favor of change, and do what I can locally to affect this.

 

[medic417]

DVT, Gullian-Barre sydrome, localized tissue ischemia, osteomalasia, sickle cell crisis, and typhus. Please list out the treatements that will be done by a paramedic vs a basic and how they will benefit the pt. Again, this thread get's repeated time and time again, for once let's make it so people can actually learn something from it. So please, give the treatements so that basic providers will know WHY people are saying that all pt's deserve an ALS assessment.

I swear I'm done now.

First we can do more for them. Some it as I already stated will just make sure they make it to the hospital. W/o getting extremely specific I can get
O2, IV's, go into the drugs if cardiac tons of choices depending on rhythm etc, can go steroidal such as solumedrol, depending on distance thrombolytic, RSI if I need to take control of air way to keep them alive, anxiety and pain management. Do you get the picture?

Really after a complete ALS exam that started with knee pain I may have to use any number of my nearly 100 drug choices. A basic can give O2 and the dreaded and should be outlawed "deisel bolus", if they figure out its not just a wasted call. If it was my family which option would I want? I want someone that can do something besides drive. Plus because of the treatment the ride will be smoother and safer for my family member. So win win by having ALS respond all calls.

 

[medic417]

I'm just saying that the care available really doesn't differ for this particular patient. Recognizing the problem, initiating basic care and transport is what we have to offer.

UMMM no we can do much more see my previous post I touched just on a few options.

 

[ffemt8978]

UMMM no we can do much more see my previous post I touched just on a few options.

So what do you do for these illnesses that a basic can't, since they were the ones listed earlier in this thread...

DVT, Gullian-Barre sydrome, localized tissue ischemia, osteomalasia, sickle cell crisis, and typhus

 

[Veneficus]

DVT, Gullian-Barre sydrome, localized tissue ischemia, osteomalasia, sickle cell crisis, and typhus. Please list out the treatements that will be done by a paramedic vs a basic and how they will benefit the pt. Again, this thread get's repeated time and time again, for once let's make it so people can actually learn something from it. So please, give the treatements so that basic providers will know WHY people are saying that all pt's deserve an ALS assessment.

I swear I'm done now.

First off, as vent pointed out, suspicion of a serious injury is the most important part.

But let’s look at some of the things you asked about:

DVT: BLS response: agitation somebody called without a “true emergency” talked into a refusal and left on scene. Perhaps a walk to the ambulance which dislodges the clot into systemic circulation? Maybe a scoop and run to the hospital where the report to the charge nurse gets the patient sent out to triage because of a “possible torn meniscus.”

ALS: suspicion of DVT in the Popliteal vein, cardiac monitor, ongoing assessment for acute ischemia in organs such as heart and brain. Transport to a facility with interventional radiology or vascular surgery. Transfer of care with a report that indicates a closer more urgent need of the patient.

Gullian- Barre as well as typhus: BLS: SAA

ALS: recognition of possible serious condition that could lead to paralysis or death if left untreated.

Sickle cell: BLS: O2 ride to hospital

ALS: O2, IV/NS or ½ normal saline which is the first line treatment to try to reduce clotting and restore perfusion.

Osteomalacia: BLS: no idea what they would make of this

ALS: realization that lack of bone density is systemic and most elderly people suffering from this are at extreme risk for a femoral neck fx. (which in persons over 65 carries a 80% mortality per year) In children can lead to life-long deformity requiring surgery.

Sepsis: BLS: O2, ride to hospital

ALS: fluid replacement as well as vasopressors.

Acute tonsillitis: BLS: Cpap

ALS: ET tube, NT tube, surgical cric. Steroids, mag sulfate

Meningitis: BLS: risk of misDx as flu

ALS: suspicion, transport, report.

That should be enough right now to demonstrate the point. If in the future you recognize the differences, please list them as part of your post.

 

[medic417]

So what do you do for these illnesses that a basic can't, since they were the ones listed earlier in this thread...

W/o going deep one key thing is pain relief. Perhaps more for some of them. Pain relief alone for someone suffering is more than enough justification for ALS response.

Am I going to break down each possible illness that could be related to the knee pain and the multiple possible treatments? No. If someone wants the education they will benefit much more by doing some research rather than relying on us handing them the answers.

Well Veneficus is much nicer than me I see.

 

[ffemt8978]

Thank you, vene....

It's about time people got away from the "I can do more than you realize", and started posting what they would actually or can do. At least if they want to make this an educational thread instead of an argument based upon the "mine is bigger" mentality.

 

[medic417]

Thank you, vene....

It's about time people got away from the "I can do more than you realize", and started posting what they would actually or can do. At least if they want to make this an educational thread instead of an argument based upon the "mine is bigger" mentality.

But it gets tiring presenting facts and giving them all the material to back it up and then being called Paragods. I have given basic reasons that clearly showed the benefit but w/o wasting my time and energy going in detail just to have the information ignored. Several posts earlier myself and Vent answered that question but w/o giving them everything as then we would be know it all jerks. This has nothing to do with the "mine is bigger mentallity" this has to do with people ignoring information provided them. But now we are the bad guys. Forget it.

 

[triemal04]

Veneficus- thank you. And that wasn't even that hard was it? And can you guess how much more effective that will be in clueing a basic into why pt's need an ALS assessment rather than simple saying (for all intents and purposes) "because I said so." (I know not everyone has, and you really haven't, but look at some of the responces so far)

This thread get's repeated probably almost on a monthly basis, and almost all the replies in this one are no different than in any other. If anybody here has ever had to be a teacher/instructor, then you probably figured out a long time ago that giving real, actual examples is very effective in getting someone to understand something, and, depending on the topic and/or person who's being taught, is MUCH more effective than only giving the theory behind it. I mean, here I was thinking that part of the reason for this website was so that people could learn...silly me.

I also think it's rather interesting that only 2 people so far (1 of whom I think is a basic) have pointed out that the most important thing that can be done for some problems is simple recognition and transport to the appropriate facility.

Edit: medic417, sorry, that's a copout and you know it. Or should. You haven't done the things you say, at best all you have done is say that people deserve an ALS assessment because they could have problem X. For the average basic, that will mean squat. Explaining what problem X is, how it's recognized by a paramedic and then treated, and what will happen if it's not is infinetely more effective. If you aren't willing to do that, you may as well cut and paste someones replies from the last incarnation of this thread because they say the same things as here, and will be just as (in)effective.

 

[medic417]

I also think it's rather interesting that only 2 people so far (1 of whom I think is a basic) have pointed out that the most important thing that can be done for some problems is simple recognition and transport to the appropriate facility.

Really a properly educated Paramedic should be able to start many things prior to getting a patient to definitive care besides just transport. Yes we may not be able to fix everything we should be able to much started so patient starts recovery that much sooner. If you have so few meds and procedures you really need to start talking to your medical director to improve the guidelines you work under.

 

[ffemt8978]

But it gets tiring presenting facts and giving them all the material to back it up and then being called Paragods. I have given basic reasons that clearly showed the benefit but w/o wasting my time and energy going in detail just to have the information ignored. Several posts earlier myself and Vent answered that question but w/o giving them everything as then we would be know it all jerks. This has nothing to do with the "mine is bigger mentallity" this has to do with people ignoring information provided them. But now we are the bad guys. Forget it.

"It gets tiring presenting facts and giving them all the material to back it up..." but it doesn't get tiring thumping your chest and saying "I can do more than you?"

I looked over this thread carefully, but I may have missed where you stated how you would treat these patients...I saw a lot of ALS is needed because it could be any of these things, but nothing that detailed what would have been done even in general terms.

Like triemal said, a lot of people come here (and to EMS forums in general) to learn. How much are they really going to learn if all they hear is Basics are worthless, Basics don't know anything, Go to medic school, and I know more than you?

So let's change that, okay? I issue an open challenge to all members of this forum. Let's stop thumping our chests and start teaching/educating.

 

[triemal04]

Really a properly educated Paramedic should be able to start many things prior to getting a patient to definitive care besides just transport. Yes we may not be able to fix everything we should be able to much started so patient starts recovery that much sooner. If you have so few meds and procedures you really need to start talking to your medical director to improve the guidelines you work under.

Really? Like what? Let's take the case of a pt with Guillian-Barre Syndrome. Their only presenting symptom is some weakness to the lower extremities. No other problems. And no changes during transport. Beyond recognition, what magical treatement will YOU do?

 

[Ridryder911]

Should we start basing upon what one can do? If this is the case, the basic level would be banned. Seriously, why not just teach first aid be done with it?

Even in that perspective, most treatment for those illnesses and injuries are not aggressively treated in the ER. So do they need to bypass that since they do not treat it as well? Other than maybe analgesics, NSAID, and splinting most torn ligament tears are treated per orthoscopy and orthopedic specialities.

I agree, after reading that many of the Paramedic programs lack educating medics properly but NOT all is that way. As Paramedics do get more education there is more emphasis is being placed upon clinical differential that having the ability to performed as a triage specialist. As more and more hospitals now become more specialized, triaging the patient to the most appropriate hospital. As now many may have Stroke Centers, Specialized Cardiac Centers that provide 24 STEMI alert and hypothermic treatment, Spinal Cord facilities, etc. Even in my rural state, there is new rules and regulations that will be based upon the Paramedics assessment, which hospital will receive the patient (similar to trauma). These assessments cannot be interpreted fully at the basic level.

Not upon so much what treatment that will be performed but what the clinical impression (diagnosis) is. Again, EMS is getting upon so much what we do, rather upon our knowledge and clinical skills. Alike many others it should be based upon.." what I know, rather just the skills I can perform"....

Unfortunately, it will not be EMS that will cause these changes. It will be done by financial instutions and the needs of the increasing over crowding of ER's. Increasing numbers of the baby boomer generation where there will be no beds for ER visits and admissions as well.

I have been attending State and Federal meeting looking at the future of EMS. I believe many are cutting it short. As economic problems increase, there will have to be alternative ways for medicine. Again, hospitals will NOT be able to accommodate just because of one thinks or desires. Alike many assume they will be automatically admitted, when in fact it admission are a rarity for several reasons. I have been reviewing some states advanced Paramedic proposals as I foresee more home health type evaluation(s) and treatments. Yes, education will have to meet those demands, but that will come along with the program.


R/r 911

 

[Summit]

DVT, Gullian-Barre sydrome, localized tissue ischemia, osteomalasia, sickle cell crisis, and typhus

While I generally agree with your points if not how you present them, triemal's point was that ALS would not deal that differently with DVT or GBS that much differently than BLS. Rickets? C'mon? You going to push Vitamin D in the field?

Cardiac, as with a host of other problems, is a different story, but is disingenuous to put out typhus presenting with knee pain as a scenario where ALS will "make the difference in quality of life." You aren't going to diagnose typhus in the field based on knee pain. An MD with access to a lab will do that. You won't give antibiotics either.

All of the examples you gave, if the C/C is knee pain, are going to be dealt with by ALS the same as BLS. Sickle cell crisis might be the only exception.

Don't pull out uncommon syndromes because you assume a Basic won't know enough to tell you what I just said here. Use good examples like cardiac. That is the core of honest debate in this subject. If your contention is ALS is the standard because they might be able to give the ED a better report that might lead them down a different path, well you can make that argument. If you want to make the argument that anyone who dials 911 could be having an MI, make that argument.