Accelerated EMT – B Program in December (14 Days)

[Tigger]

Personally and no offense to the fire guys on here, if I lived in a place with fire based EMS it would take an act of God for me to call 911 for a medical problem.

"Jack of all trades, master of none" gets even worse when you try to have dual role providers.

I guess I just don't get this attitude. Fire based EMS does not automatically equate to crappy medical care. Is there a lot of crappy medicine being practiced by fire based providers? Yes, but there is also plenty of equally bad medicine being practice by single role providers.

There are good fire medics out there, and they're more common than it seems. Competent providers rarely make the news. Everyone has a horror story, and I do too, but I also have seen firsthand some excellent patient care provided by fire-based providers.

Being associated with fire department does not have to mean that the EMS provided is low quality. If EMS is not being delivered properly, we need to look at why, and not write it off as "oh, it's just fire based EMS being fire based EMS." That's not a real answer. If there are incompetent medics who are only medics so they could get a fire job, that is a systemic cultural problem within the department, and that the department has no business providing EMS. If the providers are still operating like it's 1982, that is a department problem and again, that department has no business providing EMS.

The jack of all trades, master of one point is worth considering, but there are plenty of EMS agencies that provide more than just EMS, so by the above logic, they must not be very good either. Remember when there was the big argument over the FDNY/NYPD botched extrication and it was argued that extrication should be EMS centered? I'm not saying you agree with this line of thinking personally, but many do see EMS providers as able to provide more than just EMS.

My main point though is that you cannot judge the quality of care provided just by the type of service. Broadly stereotyping the fire service as unable to provide EMS in not a productive way to fix EMS, especially since the fire service is capable of providing first-rate quality EMS so long as the department and its culture are set up to do so.

EDIT: I realize this rather off-topic and I apologize, but I think the point still bears stating.

 

[STXmedic]

I guess I just don't get this attitude. Fire based EMS does not automatically equate to crappy medical care. Is there a lot of crappy medicine being practiced by fire based providers? Yes, but there is also plenty of equally bad medicine being practice by single role providers.

There are good fire medics out there, and they're more common than it seems. Competent providers rarely make the news. Everyone has a horror story, and I do too, but I also have seen firsthand some excellent patient care provided by fire-based providers.

Being associated with fire department does not have to mean that the EMS provided is low quality. If EMS is not being delivered properly, we need to look at why, and not write it off as "oh, it's just fire based EMS being fire based EMS." That's not a real answer. If there are incompetent medics who are only medics so they could get a fire job, that is a systemic cultural problem within the department, and that the department has no business providing EMS. If the providers are still operating like it's 1982, that is a department problem and again, that department has no business providing EMS.

The jack of all trades, master of one point is worth considering, but there are plenty of EMS agencies that provide more than just EMS, so by the above logic, they must not be very good either. Remember when there was the big argument over the FDNY/NYPD botched extrication and it was argued that extrication should be EMS centered? I'm not saying you agree with this line of thinking personally, but many do see EMS providers as able to provide more than just EMS.

My main point though is that you cannot judge the quality of care provided just by the type of service. Broadly stereotyping the fire service as unable to provide EMS in not a productive way to fix EMS, especially since the fire service is capable of providing first-rate quality EMS so long as the department and its culture are set up to do so.

EDIT: I realize this rather off-topic and I apologize, but I think the point still bears stating.

I like you.

Gotta agree here. I work for both, and agree that fire has some :censored::censored::censored::censored:ty medics, but also some GREAT ones, as does stand-alone EMS.

Might add more later, but this fire medic is freakin' tired after being woken up to give exceptional care to a chest pain patient.

 

[Handsome Robb]

I should have worded that better. Agreed there are definitely exceptional firemedics out there just like there are exceptionally :censored::censored::censored::censored:ty single roll medics.

I was doing a terrible job of trying to direct that towards EMS that is taken over by a FD, forcing providers and FFs alike to become dual roll, in most cases.

 

[systemet]

It doesn't seem like 14 day EMT programs or 900 hour paramedic programs are good for the potential growth of EMS into a profession.
I think that if you run one of those programs, you should expect to have to defend it from time to time. This doesn't appear to have been an effective marketing exercise.

 

[mikeward]

Now, on to Mr. mikeward's comments:

You sir, seem to be in the profession of fighting fire, not practicing medicine. EMS = Emergency Medical Services. FD = Fire Department. As I said before about our education, we are one of the few countries in the world that still associates EMS with FD....Think about that one for a minute. Personally and no offense to the fire guys on here, if I lived in a place with fire based EMS it would take an act of God for me to call 911 for a medical problem.

"Jack of all trades, master of none" gets even worse when you try to have dual role providers.

Hi NVRob, nice to meet you.

While my first career was with a large county fire department, I am an assistant professor of emergency medicine at a private university in Washington DC. (Yeah, that is pretty scary!)

Wow, there are few urban areas that do not run a fire-administered ambulance service or have fire company ALS 1st responders. You have used a very broad brush to make an emotional response.

So let me briefly share nuggets picked up by studying urban ems systems in the United States:

• The biggest indicator of clinical excellence is an active and involved physician medical director ... regardless of who is administering the EMS service ... fire, police, ems or a corporation.
  
• Most of our assumptions about "good" patient care crumble when we look at patient outcomes. What things should we do to increase the number of patients who can walk out of the hospital with most of their facilities intact?
  
• Both the 8:59 minute response of an ALS ambulance and staffing fire companies with dual role paramedic/firefighters are expensive and ineffective ways to improve patient outcomes.
  
• Retrospective studies in Seattle and Los Angeles have shown no change in the survival rate of witnessed VF in 25 years. Improvement in community response (public access AED, police as part of 9-1-1 ems response, aggressive compression-only civilian rescue response, pre-positioned response people in high-rises) will probably make a bigger difference in outcomes.

But this thread is about the value of a compressed EMT-Basic training program.

A well-supervised system can deliver superior clinical care by "non-caring" firefighters than a non-supervised system filled with compassionate ems caregivers.

It is not about attitude, but the competent completion of tasks within a clinical directive.

You know, ems stinks at charting. Within the same worker demographic those that become police officers learn how to "chart" criminal activity as a competent officer of the legal system. Maybe because the captain and the district attorney provides feedback and incentives?

The nursing profession has grown, even while there were mom-and-pop diploma programs similar to accelerated EMT programs.

We share the same challenge of nursing in developing appropriately credentialed educators, researchers and leaders to support the growth of the profession.

Mike

 

[JPINFV]

• Most of our assumptions about "good" patient care crumble when we look at patient outcomes. What things should we do to increase the number of patients who can walk out of the hospital with most of their facilities intact?

Is that the only metric that matters? How many people does pain management save? How many people does prehospital albuterol save?
Is increasing survival to discharge always the goal, or just the easiest metric to measure? Where does relieving pain and suffering come into play?

• Retrospective studies in Seattle and Los Angeles have shown no change in the survival rate of witnessed VF in 25 years. Improvement in community response (public access AED, police as part of 9-1-1 ems response, aggressive compression-only civilian rescue response, pre-positioned response people in high-rises) will probably make a bigger difference in outcomes.

Emphasis added.

You know, it's amazing and sad how many people balk about that, even if it's simply "train them in CPR, give them an AED, and only dispatch to cardiac arrests."

However, are cardiac arrests the best metric for EMS, or just the easiest to measure? How many cardiac arrests are beyond saving by the time EMS is even summoned?

But this thread is about the value of a compressed EMT-Basic training program.

A well-supervised system can deliver superior clinical care by "non-caring" firefighters than a non-supervised system filled with compassionate ems caregivers.

It's too bad that having both are too much to ask for. Personally, my opinion has evolved from "Boo on Fire" to "I'll support the first delivery model that will actually requires providers to have a proper foundation and think like professionals (in contrast to technicians)."

As far as the physician issue, with the recent acceptance of EMS as a proper sub-specialty of emergency medicine (much like cardiology is a sub-specialty of internal medicine), I think that the next few decades is going to see more and more physicians engaged in running the EMS system.

It is not about attitude, but the competent completion of tasks within a clinical directive.

I'd argue it is about attitude. I want someone taking care of me that is thinking past a cookbook-ocol and who isn't afraid to make tough decisions based on his/her education and training. After all, with out both the willingness to make decisions and the education and training, how do we decide which interventions and procedures needs to be done? If EMS is just about competent completion of tasks as assigned by a cookbook-ocol, then paramedic training can be distilled down to a few months of teaching individual skills as well.

Maybe because the captain and the district attorney provides feedback and incentives?

Police officer fails at charting and bad guy goes free. EMS fails at charting, and often little happens provided billing is taken care of. Of course billing can always be ran down after the fact and the worst that happens to the individual provider enters his or her name into the malpractice lawsuit lottery, and most likely his or her number won't be called, even if it's a dozy when it does get called.

 

[Fish]

I like you.

Gotta agree here. I work for both, and agree that fire has some :censored::censored::censored::censored:ty medics, but also some GREAT ones, as does stand-alone EMS.

Might add more later, but this fire medic is freakin' tired after being woken up to give exceptional care to a chest pain patient.

Yes, but I bet those stand alones are private services. I don't know of one third service EMS department that struggles clinically. I knw of plenty Private and Fire.

 

[STXmedic]

Yes, but I bet those stand alones are private services. I don't know of one third service EMS department that struggles clinically. I knw of plenty Private and Fire.

I wasn't referring to an entire service. I was referring to individual medics. But if you want to go there, I DO know of several third services that are a joke as a whole.

 

[mikeward]

JPINFV:

Measurement metrics:

"What things should we do to increase the number of patients who can walk out of the hospital with most of their facilities intact?" is not the only metric.

But in discussion with some of those engaged and involved physician medical directors, it was a question that drove a discussion that continues to rattle in my diesel exhaust pickled brain when considering EMS system design.

And one that is appropriate when talking about EMT level caregivers.

Pain management is an underserved area in prehospital paramedic care. Maybe one day EMTs can administer Nitrous Oxide.

CPR resuscitation as a valid system performance indicator

CPR survival rates have been claimed by some as an indicator of EMS system performance over a wider range of services. I do not agree, but it remains a measurement.

The U. S. Metropolitan Municipalities’ Medical Directors issued a statement: “Evidence Based Performance Measures for Emergency Medical Service Systems: A Model for Expanded EMS Benchmarking” was published in the April/June 2008 issue of Prehospital Emergency Care. [Prehospital Emergency Care 2008;12:141–151]

In that statement they eliminated any ALS response standard. The "Eagles" noted that much of the clinical research used to establish acceptable ALS response time intervals was conducted prior to the widespread dissemination of AEDs and at a time in which the compression component of CPR was not emphasized as it is now.

As a result, the consensus group proposed that EMS systems not focus response time measurement on ALS ambulances, but rather pay greater attention to first response/BLS response time to measure what it called the “most important predictive elements for optimal outcome: time elapsed until initiation of basic chest compressions and time elapsed until defibrillation attempts.”


Rochester, MN achieved the same 43% witnessed VF survival rate as Seattle/King County by dispatching AED equipped police officers on life-threatening incidents.

That was a follow-up to this presentation: Mickey Eisenberg. The C. J. Shanaberger Lecture: The Evolution of Prehospital Cardiac Care: 1966–2006 and Beyond. Prehospital Emergency Care October-December 2006 10(4) 411-417

Ventricular fibrillation in King County, Washington: a 30-year perspective.
Becker L. Gold LS. Eisenberg M. White L. Hearne T. Rea T.
Resuscitation. 79(1):22-7, 2008 Oct.

A population-based investigation of public access defibrillation: role of emergency medical services care.
Rea TD. Olsufka M. Bemis B. White L. Yin L. Becker L. Copass M. Eisenberg M. Cobb L.
Resuscitation. 81(2):163-7, 2010 Feb.

Competence over attitude

I will disagree about attitude. At the EMT level it is the competent completion of tasks within a clinical directive.

 

[Fish]

I wasn't referring to an entire service. I was referring to individual medics. But if you want to go there, I DO know of several third services that are a joke as a whole.

Name some(so that I never apply there if I ever decide to move)


Copy, I thought you were referring to the services. I know one(private) that surrounds your department that is a no good service. You know what I am talkin bouts!

 

[emt junkie]

Due to my position I am not allowed just as many others here to disclose my identity as per county rules.

This strikes a curosity in me. Why would county rules prohibit someone from dislosing who they are? The only reason I can come up with is they might be afraid if they new who you were with them it might come off as they are associated with your position on topics and might not be.

Could someone who has these rules please expand on this a bit?

 

[crazycajun]

This strikes a curosity in me. Why would county rules prohibit someone from dislosing who they are? The only reason I can come up with is they might be afraid if they new who you were with them it might come off as they are associated with your position on topics and might not be.

Could someone who has these rules please expand on this a bit?

Our county is specific regarding social media and county association. Due to the fact that anyone can search a name within the DHEC system and see what service they work for my utilization of this site along with my real name would violate county policy. This is a great site but not worth my job.

 

[systemet]

A few points:

* Yes, ALS probably makes little to no difference in cardiac arrest survival. Anyone who can get CPR and a defibrillator to a person in arrest quickly is improving their survival.

* This doesn't mean ALS isn't beneficial in other situations, e.g. pain control, respiratory distress patients, 12-lead prenotification / ER-bypass / field 'lytics, etc.

* In many other settings, the fact that there's no evidence to support ALS intervention is as more often a reflection of a lack of research than the presence of studies showing an absence of benefit.

* If the DOT, or any other governing body sets a minimum standard for our field, why do we as a community accept teaching only to that minimum standard? Why don't we demand that the bar be raised, and recognise that this will only benefit us in the long term?

* I've worked in systems where EMTs can give nitrous oxide. It's better than not giving nitrous oxide, but it's not that much better. It's just not that effective an analgesic in most of the population when given as a 50% / 50% oxygen mix. It's contraindicated in a lot of patients, causes a lot of dysphoria / nausea, is cumbersome, and often has to be discontinued at the receiving facility, which results in a period of pain until a physician is able to administer narcotic analgesia. Given the frequency with which pain control is indicated, and how often our patients are undermedicated, it makes sense to do it right from the start (my opinion, just anecdote).