Anyone been running into this lately?

[PapaBear434]

so its the same as a basic? or whats the difference?

Essentially a basic with a couple things added. Some places call them "Shock Trauma." You can start IV's, administer about ten different meds (aspirin, Benadryl, D50, glucogon, epi... simple stuff like that), give a neb treatment with albuterol, and in some jurisdictions they let you intubate (they teach it in the class as required, but my city doesn't allow it).

It's basically a gap-filler rate. Let's face it, guys, most ALS calls don't need a full blown medic most of the time. Someone with an asthma attack, someone having a diabetic episode... The Enhanced lets them take care of it, letting the medics not get tied up if something important happens. And with the big gap between basic and intermediate, some states (only two that I've heard of with Enhanced is Virginia and Minnesota, though) like to fill that hole with something.

It's not really meant as a rate to sit at. Just something to let you start getting the basic ALS stuff mastered before you start doing the more complex stuff, like EKG's and the like. The class is about a semester long, if that, with a clinical attachment. Then, of course, comes the field release program of whatever agency you're running with... But yeah, not much ed-u-ma-cation involved with it.

I think the simple solution to that is get rid of "enhanced" providers and make them get their medic. Not trying to be offensive and not attacking any individual, but I think that it is these nonstandard levels that hold EMS back as an industry.

I won't disagree that they shouldn't go and try to get their medic, or at least make it a standard nationwide. The NREMT newsletter they just sent out was pretty much dedicated to that, with almost every article talking about how the field needs to standardize to a universal qualifications and require academic achievements to start being taken more seriously.

But having SOMETHING between B and I should be included in there somewhere. It's not THAT hard to start an IV, just something you need a lot of practice at to get good with, and some times all the person needs is fluids and/or some sugar. And if you are first on scene to a major trauma before any medics get there, having someone on hand who can drop a tube, stick a large bore or two, and start pumping in fluids before the medic shows can only be a good thing. Hell, just the ability to start an IV before the medic shows so that time isn't wasted, and the medic can get right to the epi and atropine rounds and have a better chance at saving the person.

So, I guess I agree with you about 60% is what I'm saying.

 

[medic417]

But having SOMETHING between B and I should be included in there somewhere.

I disagree. There is not that much more education required to get EMT-I and honestly it is not needed. Have first responder basics and Paramedics only on the ambulance. All the in between stuff is what confuses the public. They see an ambulance and think they are safe but fail to realize that ambulance with basics or evn EMT-I's can not do much for them in a real emergency.

 

[AJ Hidell]

But having SOMETHING between B and I should be included in there somewhere. It's not THAT hard to start an IV...

It's also not that necessary. Nobody is saved by an IV alone. So then you are left arguing that you should start an IV only "because I can", or else that you need to be able to give more drugs. Either way, it's a slippery slope to nowhere.

No... there should not be anything between B and P, except for paramedic school, and a full two years of it. There is no medical justification for it, and it holds back the profession.

 

[PapaBear434]

I disagree. There is not that much more education required to get EMT-I and honestly it is not needed. Have first responder basics and Paramedics only on the ambulance. All the in between stuff is what confuses the public. They see an ambulance and think they are safe but fail to realize that ambulance with basics or evn EMT-I's can not do much for them in a real emergency.

I guess this is just something they need to hammer out above our heads. I can see your point of view, and kind of agree with it, but I have seen so many times a medic being called out for a BS call for someone having a panic attack and having to call another from WAY out of first call area to cover the cardiac arrest that just happened in Medic #1's area. And my favorite, getting a medic called to a Doc-in-the-Box because they already have an IV in place via the Doctor on hand, and thus BLS cannot take them alone.

What I would LOVE to see is your vision, but expanded. Basically make medics have a licensed position, and make them trauma nurses on wheels. Or the level of a nurse practitioner, even. They could have treat-and-release powers for the people who just need a little fluid boost or a band-aid, and be a lot more educated and ready for the big stuff. Plus, they could actually get paid a decent amount and have the respect of the rest of the medical community.

Not going to happen in the near future, of course, as no city will want to front up the money to pay for these mobile med centers. But I think it would save money in the long run, prevent unnecessary patients clogging up the ER, and ultimately save more lives when all is said and done.

Pipe dreams, of course. Fevered imaginings of a madman.

 

[PapaBear434]

It's also not that necessary. Nobody is saved by an IV alone. So then you are left arguing that you should start an IV only "because I can", or else that you need to be able to give more drugs. Either way, it's a slippery slope to nowhere.

No... there should not be anything between B and P, except for paramedic school, and a full two years of it. There is no medical justification for it, and it holds back the profession.

I disagree there. I know medics NOW that start IV's "Because they can." And no, IV's themselves have never saved lives. But I have seen a lot of time being spent trying to drop on IV on an arrest patient after they have already been down for way too long, or an unconscious diabetic patient who's veins suck so they remain unconscious waiting for a D50 while the medic(s) try for a stick.

Having someone on hand that can do that while you wait for the medic can't hurt. To me, it's like having a nurse do the blood draws so the Doctor can do the more important stuff.

 

[medic417]

They could have treat-and-release powers for the people who just need a little fluid boost or a band-aid, .

We and several services do this. Some already even keep antibiotcs, ointments, etc. Yes more education for all will lead to our type of systems being the minimum rather than the max as it seems they are now. We deny transport if after exam they do not need it, we inject for example toradol for muscle pain and release after confirming no adverse reaction, we perform many other field treatments and release. So not the future as we have done this for decade or more here. Hopefully the future brings much more and if education increases it will.

 

[AJ Hidell]

I guess this is just something they need to hammer out above our heads.

There is nothing above my head. The buck stops with me. I am responsible for the future of my profession, not some faceless "they" at some committee in Washington, D.C. You can be a part of that process too, or you can sit back and be impotent in the control of your future. The choice is yours. You may not be able to change the world, but you can change you. And one provider at a time, we can change the profession.

I can see your point of view, and kind of agree with it, but I have seen so many times a medic being called out for a BS call for someone having a panic attack and having to call another from WAY out of first call area to cover the cardiac arrest that just happened in Medic #1's area.

An EMS system should be designed to provide for those that need us most, not those who need us least. You do not dumb down an entire profession simply because a lot of your patients aren't really that sick. That is leaving those who really need us to suffer. We can hardly call ourselves EMERGENCY medical services -- much less healthcare professionals -- if our biggest concern is those who need us least, can we?

Regardless, every 911 patient needs a paramedic. Period. They may not need drugs or an invasive intervention, but paramedics are more than the sum of their skills and the content of their drug boxes. Not everyone who goes to the doctor needs drugs either, but it takes a doctor to figure that out, doesn't it? Same thing with EMS. It takes a paramedic assessment to decide whether a patient needs a paramedic or not. Lesser levels are not educated or trained to do so.

If you don't have enough paramedics, you don't just accept it and find stop-gap ways to work without them. You get them! It's really not that difficult. . Where there is a will, there is a way.

 

[PapaBear434]

We and several services do this. Some already even keep antibiotcs, ointments, etc. Yes more education for all will lead to our type of systems being the minimum rather than the max as it seems they are now. We deny transport if after exam they do not need it, we inject for example toradol for muscle pain and release after confirming no adverse reaction, we perform many other field treatments and release. So not the future as we have done this for decade or more here. Hopefully the future brings much more and if education increases it will.

Man I hope you're right. I would love to see Medics get to the point they can actually write limited prescriptions for certain meds (antibiotics, antihistamines...) based on standing orders like a NP. But the education needs to get there first, THEN the process of trying to convince the rest of the medical world that these folks are qualified and ready for a responsibility like that.

And since a good number of the medical world views us as uneducated adrenaline junkies, I can only imagine how long that would take. Which would mean that the initial folks, the first generation of these new medics, getting that level of education would very likely end up wasted and unused. I mean, hell, it wasn't just that long ago that they still made Medics transmit three leads, and now they finally trust you guys with THAT they still make you transmit the twelves.

One could only imagine how long it would take them to trust you to start handing out meds and medical advice.

 

[PapaBear434]

If you don't have enough paramedics, you don't just accept it and find stop-gap ways to work without them. You get them! It's really not that difficult. Where there is a will, there is a way.

Easy to say. But when the city budget gets strained, fire, police, and EMS are always the first to get cuts for some reason or another.

Increasing education standards means actually having to pay someone a better wage. And I think they'd rather cut off their own fingers with a paint scraper than do that.

 

[AJ Hidell]

And since a good number of the medical world views us as uneducated adrenaline junkies, I can only imagine how long that would take.

It's not how the medical community views us that is the problem. We have serious allies in the medical community who are ready to move us forward. Our problem is how we view ourselves. And right now, the majority of the people in EMS believe it's just a temp job for undereducated adrenalin junkies, a part-time gig for firefighters, a stepping stone to med school or nursing school, and a hobby for people who want a thrill. None of those people want to make a two to four year commitment just to play with the siren. Those are the people holding us back, not the medical community, the politicians, or anyone else. We are our own worst enemy.

 

[JPINFV]

And right now, the majority of the people in EMS believe it's just a temp job for undereducated adrenalin junkies, a part-time gig for firefighters, a stepping stone to med school or nursing school, and a hobby for people who want a thrill. None of those people want to make a two to four year commitment just to play with the siren. Those are the people holding us back, not the medical community, the politicians, or anyone else. We are our own worst enemy.

How do you convince those of us that are looking to advance to other levels that EMS is going to improve anytime soon? Why should we become a martyr for EMS when a large enough number of providers are fighting to maintain the status quo or regress it? While I would love to be a paramedic, I just don't see a future in EMS at this time. Too many people do not want to do what it's going to take to move paramedicine from a tech job to a practitioner profession.

 

[AJ Hidell]

Those people can't be convinced, and no effort should be wasted trying to do so. The idea of uniting EMS together to move into the future is a pipe dream. It'll never happen. Those who are going to lead us into the future will do so against the will of the majority. We will drag them kicking and screaming, and many will go away mad. I'm okay with that. That's the way that every other medical profession -- including physicians -- has had to do it, and we are certainly no better than them.

 

[reaper]

How do you convince those of us that are looking to advance to other levels that EMS is going to improve anytime soon? Why should we become a martyr for EMS when a large enough number of providers are fighting to maintain the status quo or regress it? While I would love to be a paramedic, I just don't see a future in EMS at this time. Too many people do not want to do what it's going to take to move paramedicine from a tech job to a practitioner profession.

That is the biggest problem with EMS!

Why not become a very educated Paramedic and work the job. All the while fighting for others to educate themselves as well.

How can you not see a future in EMS? If you want to be an educated Paramedic, then what is wrong with being just that?

Not all want to be supervisors. Some do this job for the medicine and helping the pt's. They are not looking to climb a ladder to an easier job. If all these people leave the profession because they see no future, then there will never be a future.

Stay and fight for change, for better education, for better EMS as a whole in this country.

That is the future that needs to be seen!

 

[PapaBear434]

It's not how the medical community views us that is the problem. We have serious allies in the medical community who are ready to move us forward. Our problem is how we view ourselves. And right now, the majority of the people in EMS believe it's just a temp job for undereducated adrenalin junkies, a part-time gig for firefighters, a stepping stone to med school or nursing school, and a hobby for people who want a thrill. None of those people want to make a two to four year commitment just to play with the siren. Those are the people holding us back, not the medical community, the politicians, or anyone else. We are our own worst enemy.

Point taken. I have seen both sides of it, but I agree that people inside the community are probably hurting it much more than those outside of it.

 

[DevilDuckie]

We have a local federal government run facility for youths or young adults age 16-21, to give them skills and job training, after a hard life or bad choices screwed up their life. The ones 18+, we get no problem. But lately, they have been refusing to give (EMS) the patient history, forms, reports, stating it's a HIPAA violation.. and won't give it to the ER either.. They won't even give us the paper that gives us permission to treat them minor child. And their parents are anywhere from jail to 200 miles away.. No phone, no way to contact them.

It's been a real PITA! Kids have anything from BS problems to head injuries to drug OD's.. and they're dying.. 70 miles from the hospital.. and these people don't understand that it's okay to inform us, to treat the child, like they completely misunderstand HIPAA. They'll give the forms to the cops, but not the ambulance, wtf is up w/ that? Stupidity kills.

 

[JPINFV]

Why not become a very educated Paramedic and work the job. All the while fighting for others to educate themselves as well.

How can you not see a future in EMS? If you want to be an educated Paramedic, then what is wrong with being just that?

Not all want to be supervisors. Some do this job for the medicine and helping the pt's. They are not looking to climb a ladder to an easier job. If all these people leave the profession because they see no future, then there will never be a future.

Stay and fight for change, for better education, for better EMS as a whole in this country.

That is the future that needs to be seen!

Large swaths of the US are essentially shut out of professional EMS. How many places choose not to have paramedics because they love their volunteers? How many EMS based fire suppression services out there hire single function paramedics and pay them anything decent? What's left pay for and have protocols for what's left, which in large part isn't good.

Unfortunately the current attitude in EMS is exactly what drives out the very people that I think EMS needs to advance. EMS tends to be anti-intellectual (ever see what happens to people who start to question traditional practices?), spineless (stock answer to any dilemma is "Call medical control." There's nothing wrong with asking for help, but there really is a point where we just have to say "I know what I'm doing, I know my protocols, and damn it, I'm going to make a decision!") and anti-education ("Let's see what I can get to do with the least amount of education and training"). As long as these attitudes (do X because I said so, call medical control if anything that doesn't fit the cook book, and we don't need no stinkin edumakation) remain and are taught in class, nothing will change and EMS will continue to drive away promising providers.

 

[PapaBear434]

How can you not see a future in EMS? If you want to be an educated Paramedic, then what is wrong with being just that?

Simple answer? People like to eat and actually make a decent wage for their considerable investment. Better pay will lead to better incentives.

 

[HasTy]

So I have been watching this thread...and while I have not directly ran into this problem my self I have been listening to the "war stories" while I am in HQ posting or waitign for shift to start and a few of the BLS cars are starting to say that they are having issues with Nurses or other parts of the staff are beginning to refuse the hand over of charts we get only the parts that they choose which is generally only the Med list and if applicable the DNR...

 

[reaper]

If you are not out to make a million dollars, the pay in EMS is pretty decent. I survive just fine in big cities and try not to work a lot of OT.

Money is never the answer to making a better system, it is just a band aid over the major problems!

 

[DevilDuckie]

What about taking patients from an SNF, and they don't keep the actual DNR on hand, only copies?

How do you handle that?