ALS = Medic/Medic, Medic/Basic, Medic/Intermediate?

[Guardian]

I disagree. An P/B team works great here. We also have fire as first response, and some of those FD's are ALS here. But if we get a BLS department....

A FF is all over the airway, bagging another is on compressions. If FD isn't there, PD or SO is and they can do it too. In the time it takes me to get the Cardiac Monitor 4 leads on and the Combo pads on she has the IV. Quick look at the monitor tells us if we're shocking. If its shockable, she does that while I set her up for intubation. If its not, I still set her up while she gets her first round of drugs in. Once she is set up, takes none to long to intubate - I hear a monkey can do it - and she is onto her drugs while I get the second line, and then I am driving down the road.

Sounds simple right....does anything ever really go that smoothly??

As a matter of fact when we get ALS fire on scene, us, and our shift commander is dispatched to all codes...well sometimes there are to many medics...

Point is, our protocols allow for the EMT to start IV's, apply the monitor, run 12 leads, glucose checks, administer albuterol, strap on CPAP....lots of stuff a lot of systems dont (Heck, our neighboring county only lets EMTs drive. its what they are hired to do. The medic does all patient care, ALS or BLS). So for our system a P/B crew works fine.....so long as they both can pull their weight.

Intubation so easy a monkey can do it? You heard wrong. Ex. 12 y/o with severe anaphylactic reaction. The child is turning blue and if you don't intubate right then and there, the child will die. Onlookers at the scene include the childs parents and family, the FF first responders, your partner, your supervisor, police, etc. You insert the laryngoscope blade and can't see a thing because of angioneurotic edema. At this moment, your career, your reputation, EMS's reputation, and most importantly this childs life is on the line and dependent of your ability to intubate. Intubation is NOT EASY!

 

[Guardian]

Rid and Guardian,

I agree with you that Paramedic should be the gold standard of care, but I'm curious as to how you would implement it in rural areas with volunteer services and almost no funding.

Just curious, are your firefighters and police officers trained at a substandard level as well?

 

[ffemt8978]

Just curious, are your firefighters and police officers trained at a substandard level as well?

Nope, but they don't require a two year program to become one either, and our FF's are our EMT's since we're a combined department.

 

[Guardian]

Nope, but they don't require a two year program to become one either, and our FF's are our EMT's since we're a combined department.

You're right. Two years is way to long and expensive when dealing with something as petty as human life.

In reality, rural ems needs highly trained paramedics more than urban ems does. My answer to your first question is do what ever you have to do to get the money. Have your governor declare a state of emergency or at the very least post your concerns here. Don't give up and say to yourself "the best we can do here is BLS." You never know, you might be the one having an MI that turns into cardiac arrest. Paramedics are saving more and more cardiac arrest victims these days while BLS/AED number of saves remain the same. Work on making EMS a real profession. Your teachers who teach your kids all have at least 4 years worth of college don't they? Volunteers are great if they can meet the gold standard but if they can't, you need to try something else.

 

[Guardian]

The only reason I'm so passionate about this is because I've seen what ALS at the paramedic level is capable of doing. A few weeks ago, a 68 y/o woman collapsed. CPR was started and an AED attached. No shock advised. At this point, with only BLS, she would have died. I showed up and put her on the monitor which read slow PEA. With high quality CPR, intubation, IV, Vaso, Atropine, and more CPR with an autopulse, the pt regained a pulse and is alive today. There are and will continue to be significant changes in ACLS that improves cardiac arrest outcomes at the paramedic level. Two years worth of education is not to much to ask for.

 

[ffemt8978]

You're right. Two years is way to long and expensive when dealing with something as petty as human life.

I never said it wasn't...as a matter of fact, you were trying to compare apples and oranges (police/fire/ems).

In reality, rural ems needs highly trained paramedics more than urban ems does. My answer to your first question is do what ever you have to do to get the money. Have your governor declare a state of emergency or at the very least post your concerns here. Don't give up and say to yourself "the best we can do here is BLS." You never know, you might be the one having an MI that turns into cardiac arrest. Paramedics are saving more and more cardiac arrest victims these days while BLS/AED number of saves remain the same. Work on making EMS a real profession. Your teachers who teach your kids all have at least 4 years worth of college don't they? Volunteers are great if they can meet the gold standard but if they can't, you need to try something else.

Okay, I agree and disagree with you here. I agree that rural EMS needs ALS more than urban areas, where the transport times to an appropriate facility are much shorter.

I disagree with you on your last statement in particular. It's very easy to say that if volunteers can't meet the standards of ALS, then something else needs to be done. Maybe it's slipped by you, but the reason that there are volunteer agencies is because the community they serve is unwilling/unable to support paid services. My agency serves about 5,000 people over 248 sq. miles. There is no way that we could afford to man an ALS service without a three-fold increase in taxes, something we are prohibited by law from even placing on the ballot. In addition, out of the 5,000 people we provide service to, only about 2,000 are voters, the rest being migrant workers.

So what's wrong with people becoming paramedics on their own dime and returning to these rural agencies, you say? It still comes down to cost. The cost of the drugs, equipment, and continuing training. You're asking an awful lot of someone that doesn't even get paid for what they do.

The only way that I see all EMS meeting the gold standard of paramedic level care is if the government (federal or state) mandates and 100% funds it. Otherwise, our current system of tiered response will remain unchanged.

 

[gradygirl]

You're right. Two years is way to long and expensive when dealing with something as petty as human life.

Dude, four years is too short and that's what doctors receive in terms of formal education. I'm sorry, but they :censored::censored::censored::censored: up royally, too.

And please let's not forget that EVERY paramedic started as an EMT-B. It's your basic level of treatment, simple as that. It's the foundation by which every career in EMS is built on. By no means am I going to stay a Basic, but that doesn't mean I have any less respect for Basics. I've gotten over the whole "well, I'm just a Basic" thing because I know at the end of the day, I can save a life, maybe not as well or without using as cool toys as a paramedic, but a save is a save.

 

[Guardian]

Cost isn't an excuse. We live in the richest country in the world. We find ways to fund public schools, police, etc., I know we can find a way to fund ems. Hospitals seem to be well funded through private and public funds, maybe we can do the same for ems. ALS at the paramedic level should be a basic necessity and not just something thats nice to have.

 

[ffemt8978]

Cost isn't an excuse.

You're right, it's not an excuse...it's the reason.

 

[MMiz]

Cost isn't an excuse. We live in the richest country in the world. We find ways to fund public schools, police, etc., I know we can find a way to fund ems. Hospitals seem to be well funded through private and public funds, maybe we can do the same for ems. ALS at the paramedic level should be a basic necessity and not just something thats nice to have.

I'm going to have to call you on this one.

Cost is the excuse. Quite simply, some areas, in fact many areas, can't afford ALS services. Many areas can't even afford BLS services.

Many areas can't find ways to fund public schools. Many communities can't find ways to fund police and fire departments. Many areas can't find ways to fund EMS.

Hospitals are struggling. Even the best and biggest hospitals aren't doing nearly as well as we think.

I'm worried that you're not seeing the problem. I'm worried that you don't see the lack of funding.

I moved from a very wealthy area, one with some of the best schools public schools in the nation, and only the newest FD equipment. Only 15 minutes away there were multiple communities that can't fund their PD, FD, or EMS. They literally closed up shop and stopped providing services. The county stepped up and provides country patrols, the FD will respond if the block is on fire, and EMS is dispatched to multiple privates, hoping one will run the call. This is the reality we live in.

As a teacher do I really need to go into the state of our public schools? Public schools are failing and closing at an alarming rate. Many public schools can no longer afford to stay open.

In rural environments there is generally a lack of ALS care, not because the people don't want it, but because they can't fund it and find people willing to work the shifts. When you can't afford it you can't afford it, I'm not sure what else you can do.

In this country less than 2% of the population owns more than 98% of the wealth.

I agree, there should be an expanded Paramedic curriculum. You've seen my many posts on it. I do not believe that everyone will benefit from the curriculum, simply because many communities can barely staff BLS units.

I believe there are nearly 20,000 volunteer fire departments in America. The need for volunteers generally has grown out of an inability to afford or staff full time paid squads. Without those departments 20,000+ communities would not have service. That's the reality right now, and we're speaking in ideals. We might as well throw in the request for a pretty pony at this point.

 

[Guardian]

So i guess you don't have public schools then. I guess your community is so poor, none of you children get educated. Part of the reason people are not willing to pay for paramedics is because they think they already have them. You'll go around calling yourselves medics and the general public doesn't know any better. You have a local government with a court system, you have police, you have waste disposal, you have schools, but for some reason the money ends right there. Absolutely no more money for anything else. Do you really expect me to believe this?

 

[Ridryder911]

Have Sheriff or Police department?.. have District Attorney?.. then there is money out there, it is not a priority to the citizens. Not everyone, will be able to have Paramedics, the same way not every community can justify a hospital as well.. but, you improvise and this will have to be a mind set change of maybe contracting out.. rendezvous with an ALS, roving Paramedic... etc... I have placed Paramedic units in towns as small as 2000, so it can be done.. but, the citizens, community leaders and yes other emergency services (FD, EMS, LEA) has to be willing to work and create a way.

It will not be easy, but it is not going to get any easier later as well... and without emergency care that is equal to and same, communities will not be able to recruit business, and population to grow.

R/r 911

 

[ffemt8978]

So i guess you don't have public schools then. I guess your community is so poor, none of you children get educated. Part of the reason people are not willing to pay for paramedics is because they think they already have them. You'll go around calling yourselves medics and the general public doesn't know any better. You have a local government with a court system, you have police, you have waste disposal, you have schools, but for some reason the money ends right there. Absolutely no more money for anything else. Do you really expect me to believe this?

You don't believe me then bring your paramedic self out to my area and work a job picking fruit in an orchard so you can volunteer to be a paramedic with my service.

Yes we have schools, which are in financial trouble; Yes we have law enforcement, underfunded and understaffed; No, we don't have a hospital because of so few people in our area.

How much does it cost to equip an ALS unit? Let's leave staffing out of it for right now. Keep in mind that we have three stations, which means three ambulances.
- We would have to purchase three 12 lead ECG's
- We would have to purchase everything necessary to intubate patients for three rigs and to have on hand supplies at the station for restocking
- We would have to purchase all of the drugs except D50 and Albuterol

That's a lot of money to lay out for a community of 5000 people. We have an ALS unit that is approximately 30 minutes away, and our community knows this. Our community knows we are not paramedics but EMT-I's, EMT-B's, and First Responders. We have educated our community as to what services we can provide and what we can't. The people in our area that expect every amublance to be staffed with Johnny and Roy paramedics are the ones that come and visit our area from a community that has every ambulance staffed with ALS (such as Seattle).

 

[gradygirl]

So i guess you don't have public schools then. I guess your community is so poor, none of you children get educated.

Whoa, whoa. I go to a very well endowed school, and we damn well nearly pay out of our pockets for things. At almost $45,000 in tuition a year per student and about 2,500 students (go ahead, do the math), our squad has a meager spending budget and we are totally volunteer. We're having real staffing issues because of this; our numbers are starting to drop and we've had to cut back our call times by about a third. We're only now, after 10 years of being a proud vollie service, fighting to get some sort of monetary compensation and incentives for our current and prospective members. And trust me, we wouldn't be if it weren't for our dwindling numbers.

Our budget is another thing we must fight for; we are guaranteed a budget only because we provide an invaluable service to the school. As y'all know, EMS is not at all cheap to restock; we also pay for our member's training. Every dime we are given is spent trying to keep us on an even plane.

 

[Guardian]

You don't believe me then bring your paramedic self out to my area and work a job picking fruit in an orchard so you can volunteer to be a paramedic with my service.

Yes we have schools, which are in financial trouble; Yes we have law enforcement, underfunded and understaffed; No, we don't have a hospital because of so few people in our area.

How much does it cost to equip an ALS unit? Let's leave staffing out of it for right now. Keep in mind that we have three stations, which means three ambulances.
- We would have to purchase three 12 lead ECG's
- We would have to purchase everything necessary to intubate patients for three rigs and to have on hand supplies at the station for restocking
- We would have to purchase all of the drugs except D50 and Albuterol

That's a lot of money to lay out for a community of 5000 people. We have an ALS unit that is approximately 30 minutes away, and our community knows this. Our community knows we are not paramedics but EMT-I's, EMT-B's, and First Responders. We have educated our community as to what services we can provide and what we can't. The people in our area that expect every amublance to be staffed with Johnny and Roy paramedics are the ones that come and visit our area from a community that has every ambulance staffed with ALS (such as Seattle).

When you said yes to having police and schools, you told me everything I needed to know.

Your people really know the difference between EMT-I and EMT-B, are you saying that with a straight face?

No hospitals, you guys really really really need the gold standard then.

 

[MMiz]

So i guess you don't have public schools then. I guess your community is so poor, none of you children get educated. Part of the reason people are not willing to pay for paramedics is because they think they already have them. You'll go around calling yourselves medics and the general public doesn't know any better. You have a local government with a court system, you have police, you have waste disposal, you have schools, but for some reason the money ends right there. Absolutely no more money for anything else. Do you really expect me to believe this?

I think it's time for a field trip. I'd like to welcome you to Detroit. When you're done you can check out Highland Park.

It's hard to fund the services when there is either a very small tax base, or a large population with a very small population that pays taxes and for services.

 

[Guardian]

I think it's time for a field trip. I'd like to welcome you to Detroit. When you're done you can check out Highland Park.

It's hard to fund the services when there is either a very small tax base, or a large population with a very small population that pays taxes and for services.

I already know they have schools in detroit and highland part. No reason for me to go there.

 

[ems_is_4_me]

I Just Have To Say Some Thing I Work For A Small Service In Oklahoma And We Are Paid And It Is Hard To Find Paramedics That Are Willing To Work For The Pay And Dont Say Pay More Not All Service Are Made Of Money

 

[gradygirl]

Guardian, where do you work to have the luxury of not having cost as an excuse?

 

[Guardian]

Some of you will disagree with me. You're entitled to your opinion just like I am. I'd like to make one last closing argument on this topic. Nobody knows where the universe ends or if it ends. We are capable of anything. It is possible for humans to live and thrive on the surface of the sun. Nothing is impossible given the right amount of time and resources (when I say resources, I'm not talking about something as petty and meaningless as money, I'm talking about ambition). When someone says they can't do something, what they are really saying is they don't want to devote the time or resources to do it. We are capable of anything until someone proves otherwise.